Provider Demographics
NPI:1306894589
Name:BROWN, BILLY L (DO)
Entity type:Individual
Prefix:DR
First Name:BILLY
Middle Name:L
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SPRINGSIDE DR
Mailing Address - Street 2:#100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:#304
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-291-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0535504Medicaid
OHC02435Medicare UPIN
OH0535504Medicaid