Provider Demographics
NPI:1073812970
Name:BROWN, BERNARD III
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:BROWN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 JEFFERSON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-7233
Mailing Address - Country:US
Mailing Address - Phone:225-802-4601
Mailing Address - Fax:
Practice Address - Street 1:2609 LAUREL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5525
Practice Address - Country:US
Practice Address - Phone:225-802-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program