Provider Demographics
NPI:1043366925
Name:BROWN, GARRY J (DO)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0256
Mailing Address - Country:US
Mailing Address - Phone:785-823-0633
Mailing Address - Fax:785-823-0658
Practice Address - Street 1:1501 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3020
Practice Address - Country:US
Practice Address - Phone:417-326-7200
Practice Address - Fax:417-326-7201
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050412072085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20091105Medicaid
MO146240006OtherPTAN
AR161641103Medicaid
KS16701011OtherMEDICARE
KS200721240AMedicaid
MO20091105Medicaid
MO20091105Medicaid