Provider Demographics
NPI:1306841093
Name:BROWN, RICHARD J (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W 7TH ST
Mailing Address - Street 2:STE 409
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2414
Mailing Address - Country:US
Mailing Address - Phone:513-621-4370
Mailing Address - Fax:513-621-4375
Practice Address - Street 1:37 W 7TH ST
Practice Address - Street 2:STE 409
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2414
Practice Address - Country:US
Practice Address - Phone:513-621-4370
Practice Address - Fax:513-621-4375
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001785213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0323082Medicaid
OH480933146OtherRAILROAD MEDICARE
OH310898706026OtherCARE SOURCE
OH0429501Medicare ID - Type Unspecified
OHT80434Medicare UPIN
OH1050740001Medicare NSC