Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 152528 | MA |
NPI | 1629228580 |
---|---|
Provider Name | Dr. Karla Renee Cheatham Brown |
First Address | Carbondale, IL 62902-7523 |
Second Address | Carbondale, IL 62902-7523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2008 |
Last Update Date | 26/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1557048 | (05) | LA |
F57212 | (02) | LA |