Provider Demographics
NPI:1053305482
Name:BROWN, WALTER DWAYNE (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:DWAYNE
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 1:155 HOSPITAL DR
Mailing Address - Street 2:STE 206
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2852
Mailing Address - Country:US
Mailing Address - Phone:337-234-3204
Mailing Address - Fax:337-234-3599
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:STE 206
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-234-3204
Practice Address - Fax:337-234-3599
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07368R207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1929255Medicaid
LA5K085Medicare ID - Type Unspecified
D79341Medicare UPIN