Provider Demographics
NPI:1558651224
Name:BROWN, RYAN RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:RANDALL
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 1:535 W SECOND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1275
Mailing Address - Country:US
Mailing Address - Phone:859-687-6595
Mailing Address - Fax:859-403-3015
Practice Address - Street 1:535 W SECOND ST STE 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1275
Practice Address - Country:US
Practice Address - Phone:859-687-6595
Practice Address - Fax:859-403-3015
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY48688OtherLICENSE
KY48688OtherLICENSE
KY48688OtherLICENSE