Provider Demographics
NPI:1891794277
Name:BROWN, DONALD WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYNE
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MEDPARK DRIVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-531-4100
Mailing Address - Fax:606-220-2116
Practice Address - Street 1:25 MEDPARK DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:270-796-3330
Practice Address - Fax:270-796-3338
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY027502086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64051659Medicaid
KY0566707Medicare ID - Type Unspecified
KY64051659Medicaid