Provider Demographics
NPI:1992725519
Name:BROWN, RANDALL J (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:J
Last Name:BROWN
Suffix:
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 1:1902 MAY ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1200
Mailing Address - Country:US
Mailing Address - Phone:785-562-3942
Mailing Address - Fax:785-562-5149
Practice Address - Street 1:1902 MAY ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1200
Practice Address - Country:US
Practice Address - Phone:785-562-3942
Practice Address - Fax:785-562-5149
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS419667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE20483OtherBC/BS NE
KS608151OtherFIRST GUARD
KS046810OtherBC/BS KS
KS608151OtherFIRST GUARD
KS046810OtherBC/BS KS