Provider Demographics
NPI:1790767515
Name:BROWN-PURYEAR, LATONYA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LATONYA
Middle Name:A
Last Name:BROWN-PURYEAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LATONYA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-212-7700
Mailing Address - Fax:859-212-7710
Practice Address - Street 1:4900 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4824
Practice Address - Country:US
Practice Address - Phone:859-212-7700
Practice Address - Fax:859-212-7710
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087050207RC0200X, 207RP1001X
KY41854207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2614219Medicaid
KY7100069580Medicaid
KYP00873390OtherRAIL ROAD MEDICARE
KYP00676674OtherRAILROAD MEDICARE
KY008580012Medicare PIN
OHBR4173181Medicare PIN
KY7100069580Medicaid
OHI45566Medicare UPIN
KY0387555Medicare PIN