Provider Demographics
NPI:1295019875
Name:BROWN, GARY LANE (RPA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LANE
Last Name:BROWN
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26138 MYRTLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6583
Mailing Address - Country:US
Mailing Address - Phone:225-243-5535
Mailing Address - Fax:
Practice Address - Street 1:4570 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-5603
Practice Address - Country:US
Practice Address - Phone:225-298-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06LA1227243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant