Provider Demographics
NPI:1578761011
Name:BROWN, CALVIN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:CHRISTOPHER
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 1:6005 PARK AVE STE 624
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:731-427-7799
Mailing Address - Fax:731-424-9927
Practice Address - Street 1:6760 GOODMAN RD STE 125
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7056
Practice Address - Country:US
Practice Address - Phone:901-682-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7330207W00000X
TXP5039207W00000X
TNMD0000047139207W00000X
ARE7330207WX0107X
MS21670207WX0107X, 207W00000X
TN47139207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03526827Medicaid
TX323924601Medicaid
AR188120001Medicaid
TN1525893Medicaid
MO1578761011Medicaid
TNP00975599OtherPALMETTO RR MEDICARE
MS03526827Medicaid
TN103I181970Medicare PIN
MO1578761011Medicaid
MS302I186478Medicare PIN