Provider Demographics
NPI:1821186941
Name:BROWN, GREGORY WENDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WENDELL
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:PO BOX 1067
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1067
Mailing Address - Country:US
Mailing Address - Phone:812-471-1591
Mailing Address - Fax:812-471-6650
Practice Address - Street 1:1314 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2860
Practice Address - Country:US
Practice Address - Phone:812-254-2760
Practice Address - Fax:812-471-6650
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036499A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200008180AMedicaid
IN200008180AMedicaid
ININ2524Medicare PIN