Provider Demographics
NPI:1235108630
Name:BROWN, RICHARD DEXTER (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEXTER
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 1:628 WILTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6138
Mailing Address - Country:US
Mailing Address - Phone:207-778-2245
Mailing Address - Fax:207-779-1098
Practice Address - Street 1:628 WILTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6138
Practice Address - Country:US
Practice Address - Phone:207-778-2245
Practice Address - Fax:207-779-1098
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014299207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1437336880Medicaid
040443OtherANTHEM BC/BS PIN NUMBER
040443OtherANTHEM BC/BS PIN NUMBER
MM6433Medicare ID - Type Unspecified
ME1437336880Medicaid