Provider Demographics
NPI:1508055104
Name:BROWN, PETER ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROSS
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9601 165TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5660
Mailing Address - Country:US
Mailing Address - Phone:708-646-8070
Mailing Address - Fax:815-464-9737
Practice Address - Street 1:9601 165TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5660
Practice Address - Country:US
Practice Address - Phone:708-646-8070
Practice Address - Fax:815-464-9737
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL93147Medicare PIN