Provider Demographics
NPI:1891746913
Name:BROWN, DOUGLAS KEITH (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:KEITH
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 1:302 N HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:KS
Mailing Address - Zip Code:66743-2000
Mailing Address - Country:US
Mailing Address - Phone:620-724-8291
Mailing Address - Fax:
Practice Address - Street 1:302 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:KS
Practice Address - Zip Code:66743-2000
Practice Address - Country:US
Practice Address - Phone:620-724-8291
Practice Address - Fax:620-724-6332
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS101664OtherBCBS
KS100408400DMedicaid
KS100408400DMedicaid
KS101664Medicare PIN
KSP00062835Medicare PIN