Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01068195A | IN |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 01068195A | IN |
NPI | 1740378215 |
---|---|
Provider Name | Dr. Ryan P Brown |
First Address | Muncie, IN 47303-4988 |
Second Address | Muncie, IN 47304-3988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 22/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201019410 | (05) | IN |
P01277189 | RAILROAD MEDICARE (01) | IN |