Provider Demographics
NPI:1346390093
Name:BROWN, JEFF T (DO)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:T
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:903 MISSISSIPPI DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-0928
Mailing Address - Country:US
Mailing Address - Phone:662-377-7900
Mailing Address - Fax:662-377-7925
Practice Address - Street 1:903 MISSISSIPPI DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0928
Practice Address - Country:US
Practice Address - Phone:662-377-7900
Practice Address - Fax:662-377-7925
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS19536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512I080086Medicare PIN