Provider Demographics
NPI:1396988762
Name:BROWN, GARY W JR (NP-C)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:W
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1582 N BROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-4385
Mailing Address - Country:US
Mailing Address - Phone:423-626-0277
Mailing Address - Fax:423-626-0082
Practice Address - Street 1:1582 N BROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-4352
Practice Address - Country:US
Practice Address - Phone:423-626-0277
Practice Address - Fax:423-626-0082
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14103363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14103OtherMEDICAL LICENSURE