Provider Demographics
NPI:1689625543
Name:BROWN, DESRENE K (MD)
Entity Type:Individual
Prefix:
First Name:DESRENE
Middle Name:K
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 HARMON RD
Mailing Address - Street 2:PO BOX 129
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817
Mailing Address - Country:US
Mailing Address - Phone:419-369-4600
Mailing Address - Fax:419-369-4603
Practice Address - Street 1:547 HARMON RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817
Practice Address - Country:US
Practice Address - Phone:419-369-4600
Practice Address - Fax:419-369-4603
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076441207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBR0895734OtherMEDICARE OTTAWA
OH2149624Medicaid
OHBR0895734OtherMEDICARE OTTAWA
OHBR0895735Medicare PIN