Provider Demographics
NPI:1689672032
Name:BROWN, MARK FREDERICK (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:FREDERICK
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:939 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106
Mailing Address - Country:US
Mailing Address - Phone:318-681-6174
Mailing Address - Fax:318-681-7695
Practice Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP STE 310
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3154
Practice Address - Country:US
Practice Address - Phone:318-212-5880
Practice Address - Fax:318-212-5885
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0180872086S0120X
LAMD.0180872086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1971961Medicaid
LAB96723Medicare UPIN
LA1971961Medicaid
B96723Medicare UPIN
LA5R874CQ62Medicare PIN
LA4M783CQ62Medicare PIN