Provider Demographics
NPI:1922038777
Name:BROWN, JOSEPH D (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5909
Mailing Address - Country:US
Mailing Address - Phone:660-826-5897
Mailing Address - Fax:660-826-4691
Practice Address - Street 1:519 E 13TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5909
Practice Address - Country:US
Practice Address - Phone:660-826-5897
Practice Address - Fax:660-826-4691
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000587213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
L810415Medicare ID - Type Unspecified
U05655Medicare UPIN