Provider Demographics
NPI:1558321612
Name:BROWN, COLUMBUS IV (MD)
Entity Type:Individual
Prefix:
First Name:COLUMBUS
Middle Name:
Last Name:BROWN
Suffix:IV
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 1:9101 KANIS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6456
Mailing Address - Country:US
Mailing Address - Phone:501-217-9382
Mailing Address - Fax:
Practice Address - Street 1:9101 KANIS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6456
Practice Address - Country:US
Practice Address - Phone:501-217-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2743207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149836001Medicaid
ARH80884Medicare UPIN
AR341939YY8GMedicare PIN