Provider Demographics
NPI:1659597524
Name:BROWN, DEREK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JOSEPH
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2504
Mailing Address - Country:US
Mailing Address - Phone:620-343-6800
Mailing Address - Fax:620-341-7821
Practice Address - Street 1:1301 W 12TH AVE STE 301C
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2589
Practice Address - Country:US
Practice Address - Phone:620-340-6164
Practice Address - Fax:620-341-7766
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-117704170100000X
KS04-34047208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics