Provider Demographics
NPI:1962499699
Name:BROWN, FREDERICK L (DPM)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:L
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 1:535 E SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2637
Mailing Address - Country:US
Mailing Address - Phone:330-725-7075
Mailing Address - Fax:330-725-3988
Practice Address - Street 1:535 E SMITH RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2637
Practice Address - Country:US
Practice Address - Phone:330-725-7075
Practice Address - Fax:330-725-3988
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001409213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0267214Medicaid
OH000000130372OtherANTHEM BCBS
T80311Medicare UPIN
OH5231530001Medicare NSC
OHBR0012971Medicare PIN