Provider Demographics
NPI:1477654317
Name:BROWN, RICHARD DEAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
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 38
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0038
Mailing Address - Country:US
Mailing Address - Phone:812-738-4251
Mailing Address - Fax:
Practice Address - Street 1:5855 N HWY 11 SE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:IN
Practice Address - Zip Code:47117
Practice Address - Country:US
Practice Address - Phone:812-969-2959
Practice Address - Fax:812-969-8081
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032020A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100128270AMedicaid
IND70821Medicare UPIN
IN848020Medicare ID - Type Unspecified