Provider Demographics
NPI:1114349628
Name:BROWN, SAUL III
Entity Type:Individual
Prefix:
First Name:SAUL
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 1:771 MISTLETOE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1341
Mailing Address - Country:US
Mailing Address - Phone:330-903-3181
Mailing Address - Fax:
Practice Address - Street 1:771 MISTLETOE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1341
Practice Address - Country:US
Practice Address - Phone:330-903-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085429Medicare PIN