Provider Demographics
NPI:1821058181
Name:BROWN, GREGORY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:JAMES
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1220 PIERREMONT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1912
Mailing Address - Country:US
Mailing Address - Phone:318-629-5036
Mailing Address - Fax:318-629-5023
Practice Address - Street 1:1220 PIERREMONT RD
Practice Address - Street 2:SUITE B
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1912
Practice Address - Country:US
Practice Address - Phone:318-629-5036
Practice Address - Fax:318-629-5023
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0204522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487918454OtherNPI
LA1988987Medicaid
LA5U431Medicare ID - Type Unspecified