Provider Demographics
NPI:1265408637
Name:BROWN, RONALD DUANE (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DUANE
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10448 GULDEN AVE NW
Mailing Address - Street 2:
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358
Mailing Address - Country:US
Mailing Address - Phone:320-963-3054
Mailing Address - Fax:
Practice Address - Street 1:1630 ANDERSON AVE
Practice Address - Street 2:WHITESELL MEDICAL STAFFING
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313
Practice Address - Country:US
Practice Address - Phone:763-682-5906
Practice Address - Fax:763-684-0243
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN36485207Q00000X
MNMN23425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D79997Medicare UPIN