Provider Demographics
NPI:1427247139
Name:GARY R. BROWN, M.D.
Entity type:Organization
Organization Name:GARY R. BROWN, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NUNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-893-2620
Mailing Address - Street 1:1011 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3631
Mailing Address - Country:US
Mailing Address - Phone:985-893-2620
Mailing Address - Fax:985-893-3050
Practice Address - Street 1:1011 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3631
Practice Address - Country:US
Practice Address - Phone:985-893-2620
Practice Address - Fax:985-893-3050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY ROSS BROWN, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-18
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD02912R207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1132896Medicaid
LA1132896Medicaid