Provider Demographics
NPI:1750325015
Name:BROWN, DOUGLAS RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RANDALL
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 1:727 E WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5451
Mailing Address - Country:US
Mailing Address - Phone:918-426-2442
Mailing Address - Fax:918-426-0050
Practice Address - Street 1:727 E WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5451
Practice Address - Country:US
Practice Address - Phone:918-426-2442
Practice Address - Fax:918-426-0050
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100146180CMedicaid
OK800522447Medicare PIN
OK100146180CMedicaid