Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | K7252 | TX |
NPI | 1023024395 |
---|---|
Provider Name | Dr. Mark Thomas Brown |
First Address | Gallipolis, OH 45631-1562 |
Second Address | Gallipolis, OH 45631-1560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0378080 | (05) | OH |
040541703 | (05) | TX |
G03392 | (02) |