Provider Demographics
NPI:1013429174
Name:BROWN, DONTE' T
Entity Type:Individual
Prefix:
First Name:DONTE'
Middle Name:T
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2932
Mailing Address - Country:US
Mailing Address - Phone:508-904-4574
Mailing Address - Fax:
Practice Address - Street 1:1841 HEMINGWAY DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2932
Practice Address - Country:US
Practice Address - Phone:508-904-4574
Practice Address - Fax:508-904-4574
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator