Provider Demographics
NPI:1689655888
Name:BROWN, TERRY T (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:T
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:PO BOX 32364
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2364
Mailing Address - Country:US
Mailing Address - Phone:800-343-2599
Mailing Address - Fax:865-531-2722
Practice Address - Street 1:801 E WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3052
Practice Address - Country:US
Practice Address - Phone:775-423-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY383252085R0202X
NV140892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00269674OtherRAILROAD MEDICARE
IN200531630Medicaid
KY64110067Medicaid
KY000000370919OtherANTHEM
KY0276172Medicare ID - Type Unspecified
KYI34573Medicare UPIN
KY0929203Medicare ID - Type Unspecified
NVFN348ZMedicare PIN