Provider Demographics
NPI:1417965021
Name:BROWN, BRIAN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2510
Mailing Address - Country:US
Mailing Address - Phone:573-592-6550
Mailing Address - Fax:573-592-6673
Practice Address - Street 1:10 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2510
Practice Address - Country:US
Practice Address - Phone:573-592-6550
Practice Address - Fax:573-592-6673
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104705207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208181917Medicaid
MO208181917Medicaid