Provider Demographics
NPI:1932189719
Name:BROWN, DARRELL JAMES JR (MD)
Entity type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:JAMES
Last Name:BROWN
Suffix:JR
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 1:1003 FRED LAGRONE DR
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-4546
Mailing Address - Country:US
Mailing Address - Phone:870-364-3800
Mailing Address - Fax:870-364-3811
Practice Address - Street 1:1755 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-4080
Practice Address - Country:US
Practice Address - Phone:434-447-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00872207V00000X
ARE10222207V00000X
SC36082TL207V00000X
OH35066004207V00000X
VA0101244420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932189719Medicaid
SC360825Medicaid
OH0945295Medicaid
NC5907917Medicaid
AR218526001Medicaid