Provider Demographics
NPI:1952315905
Name:BROWN, VICKI JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:JEAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-1667
Mailing Address - Country:US
Mailing Address - Phone:419-935-0196
Mailing Address - Fax:419-933-7616
Practice Address - Street 1:315 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1667
Practice Address - Country:US
Practice Address - Phone:419-935-0196
Practice Address - Fax:419-933-7616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0154014Medicaid
OH282765955008OtherMEDICAL MUTUAL, WILLARD
OH000000136989OtherANTHEM BC/BS
OHBR0785101Medicare ID - Type Unspecified
OH000000136989OtherANTHEM BC/BS