Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01076363A | IN |
N | 207Q00000X | Family Doctor | 35131332 | OH |
NPI | 1003233263 |
---|---|
Provider Name | Gordon Brown |
First Address | Evansville, IN 47706-1510 |
Second Address | Newburgh, IN 47630-8900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 29/07/2020 |