Provider Demographics
NPI:1013734581
Name:BROWN, ETHAN JAMES
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:JAMES
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 1:7901 KIMLOUGH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2622
Mailing Address - Country:US
Mailing Address - Phone:317-478-4123
Mailing Address - Fax:
Practice Address - Street 1:2027 N DUNN ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1470
Practice Address - Country:US
Practice Address - Phone:317-478-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program