Provider Demographics
NPI:1871677062
Name:SHERVONDALONN R BROWN, MD, LLC
Entity Type:Organization
Organization Name:SHERVONDALONN R BROWN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-454-6000
Mailing Address - Street 1:7855 HOWELL BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807-5239
Mailing Address - Country:US
Mailing Address - Phone:225-454-6000
Mailing Address - Fax:225-454-6010
Practice Address - Street 1:7855 HOWELL BLVD
Practice Address - Street 2:STE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5239
Practice Address - Country:US
Practice Address - Phone:225-454-6000
Practice Address - Fax:225-454-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1583405Medicaid
I61702Medicare UPIN
4K246CV26Medicare PIN
5CV26Medicare PIN