Provider Demographics
NPI:1518305945
Name:BROWN, JORDAN DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DAVID
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 WASHINGTON VILLAGE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4094
Mailing Address - Country:US
Mailing Address - Phone:937-531-0195
Mailing Address - Fax:937-531-0196
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR STE 130
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4094
Practice Address - Country:US
Practice Address - Phone:937-531-0195
Practice Address - Fax:937-531-0196
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.011770208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0296428Medicaid