Provider Demographics
NPI:1083614291
Name:BROWN, DAVID EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-0607
Mailing Address - Country:US
Mailing Address - Phone:913-904-8446
Mailing Address - Fax:
Practice Address - Street 1:250 SE 15TH RD
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-9272
Practice Address - Country:US
Practice Address - Phone:417-681-5284
Practice Address - Fax:417-681-5505
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS0520825208600000X
MOR8707208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS057860OtherBCBS OF KS
KS431270614OtherTRIWEST
MO241757137Medicaid
MO25662015OtherBCBS OF KC(IND)
KS120000760OtherRR MEDICARE
KS100189880-CMedicaid
MO25661017OtherBCBS OF KC(GRP)
MO25662015OtherBCBS OF KC(IND)
MO241757137Medicaid