Provider Demographics
NPI:1801846779
Name:BROWN, RONALD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DAVID
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 1:20002 E WILDERNESS TRCE
Mailing Address - Street 2:
Mailing Address - City:COOKSON
Mailing Address - State:OK
Mailing Address - Zip Code:74427-2090
Mailing Address - Country:US
Mailing Address - Phone:918-200-2369
Mailing Address - Fax:918-457-4889
Practice Address - Street 1:20002 E WILDERNESS TRCE
Practice Address - Street 2:
Practice Address - City:COOKSON
Practice Address - State:OK
Practice Address - Zip Code:74427-2090
Practice Address - Country:US
Practice Address - Phone:918-200-2369
Practice Address - Fax:918-457-4889
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200089070AMedicaid
OKI55399Medicare UPIN
OK200089070AMedicaid