Provider Demographics
NPI:1992784904
Name:BROWN, DOUGLAS R (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
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 1:2400 PINE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7803
Mailing Address - Country:US
Mailing Address - Phone:715-847-2022
Mailing Address - Fax:
Practice Address - Street 1:2400 PINE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7803
Practice Address - Country:US
Practice Address - Phone:715-847-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40651208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA2951023818OtherPREFFERED ONE
MN062227300Medicaid
MI0201111271OtherBLUE CROSS PIN
41084933956001C130OtherCHAMPUS
WI62227300Medicaid
MN122980OtherUCARE
MNHP26576OtherHEALTH PARTNERS
MI5000030Medicaid
MN1045807OtherAMERICAS PPO
020039235OtherRR MEDICARE
MN1700203OtherMEDICA
MN29B02BROtherBCBS
MN1700203OtherMEDICA
MN29B02BROtherBCBS
MNNA2951023818OtherPREFFERED ONE
MN29B02BROtherBCBS
020039235OtherRR MEDICARE
WI62227300Medicaid