Provider Demographics
NPI:1003963414
Name:DOUGLAS LLOYD BROWN, M.D., S.C.
Entity type:Organization
Organization Name:DOUGLAS LLOYD BROWN, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-966-3854
Mailing Address - Street 1:17160 W NORTH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4437
Mailing Address - Country:US
Mailing Address - Phone:262-797-6770
Mailing Address - Fax:262-797-6772
Practice Address - Street 1:17160 W NORTH AVE STE 202
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4437
Practice Address - Country:US
Practice Address - Phone:262-797-6770
Practice Address - Fax:262-797-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty