Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2019006664 | MO |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 61546 | KS |
NPI | 1114347861 |
---|---|
Provider Name | Zachary L Brown |
First Address | Kansas City, MO 64112-1360 |
Second Address | Kansas City, MO 64112-1360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 27/09/2020 |