Provider Demographics
NPI:1932141827
Name:BROWN, WILLIAM RAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RAY
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:190 KIMEL PARK DR STE 155
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-765-6637
Practice Address - Fax:336-765-6964
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16834207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8919205Medicaid
NC1221401OtherUNITED HEALTHCARE
NC19205OtherBCBSNC
NC1221401OtherUNITED HEALTHCARE
NC8919205Medicaid