Provider Demographics
NPI:1245233980
Name:BROWN, KEVIN FRANK (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:FRANK
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3880 STOCKTON HILL RD
Mailing Address - Street 2:SUITE 103-135
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0595
Mailing Address - Country:US
Mailing Address - Phone:928-377-9182
Mailing Address - Fax:702-900-9648
Practice Address - Street 1:2812 SILVER CREEK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8309
Practice Address - Country:US
Practice Address - Phone:928-763-7404
Practice Address - Fax:928-763-9795
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-25
Last Update Date:2019-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ4550OtherLICENSE
AZ185299Medicaid
AZP00424009OtherRAILROAD MEDICARE PTAN
AZZ116535OtherMEDICARE PTAN
AZ116535Medicare PIN