Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11436 | MD |
NPI | 1013042274 |
---|---|
Provider Name | Dr. Wayman J Brown |
First Address | Upper Marlboro, MD 20774-1628 |
Second Address | Upper Marlboro, MD 20774-1628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |