Provider Demographics
NPI:1285695171
Name:BROWN, SCOTT DUFF (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DUFF
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 FREY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1734
Mailing Address - Country:US
Mailing Address - Phone:615-792-1199
Mailing Address - Fax:615-792-9331
Practice Address - Street 1:342 FREY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1734
Practice Address - Country:US
Practice Address - Phone:615-792-1199
Practice Address - Fax:615-792-9331
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009834Medicaid
103I082193Medicare PIN
TNQ009834Medicaid
TN0443930OtherMEDICAID PTAN AS A RURAL HEALTH CLINIC
103I082193Medicare PIN
TN3370759Medicaid
443930OtherMEDICARE PTAN AS A RURAL HEALTH CLINIC