Provider Demographics
NPI:1578607149
Name:BROWN, GARLAND RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GARLAND
Middle Name:RICHARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5522 W HAMILTON RD S
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9413
Mailing Address - Country:US
Mailing Address - Phone:260-672-2049
Mailing Address - Fax:260-427-6554
Practice Address - Street 1:1007 THREE RIVERS N
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1334
Practice Address - Country:US
Practice Address - Phone:260-422-8821
Practice Address - Fax:260-472-6554
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ININ0203082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC24147Medicare UPIN