Provider Demographics
NPI:1245567106
Name:BROWN, WILLIAM DEAN
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DEAN
Last Name:BROWN
Suffix:
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:PO BOX 3275
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38502-3275
Mailing Address - Country:US
Mailing Address - Phone:931-526-2033
Mailing Address - Fax:931-526-7500
Practice Address - Street 1:2004 GRADEMERE DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-7799
Practice Address - Country:US
Practice Address - Phone:931-526-2033
Practice Address - Fax:931-526-7500
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1431171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor