Provider Demographics
NPI:1982651352
Name:BROWN, MARK ALLEN (PA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4024
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4024
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-881-7638
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:WEST TOWER, SUITE 700
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-881-7638
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-02092363AS0400X
MO2005004531363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0215422OtherDEPARTMENT OF LABOR WA
MO23083OtherCOX HEALTH PLANS UPI
MOQ42967OtherUSPS (W/C)
MO0604585OtherUNITED HEALTHCARE
MO195811OtherATHEM BLUE CROSS/SHIELD
MO18942OtherCOX HEALTH PLANS
MO502277007Medicaid
MOQ42967Medicare UPIN
MO0604585OtherUNITED HEALTHCARE
MOQ42967OtherUSPS (W/C)