Provider Demographics
NPI:1497779755
Name:BROWN, KENNETH E (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
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 1:425 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8131
Mailing Address - Country:US
Mailing Address - Phone:318-445-7355
Mailing Address - Fax:318-487-8035
Practice Address - Street 1:425 SCOTT ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8131
Practice Address - Country:US
Practice Address - Phone:318-445-7355
Practice Address - Fax:318-487-8035
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109963207Q00000X
LA025349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109963Medicaid
LA1425079Medicaid
ILK13930Medicare ID - Type Unspecified
LA1425079Medicaid