Provider Demographics
NPI:1295725570
Name:BROWN, RICHARD J (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:738 FORKS RD
Mailing Address - Street 2:
Mailing Address - City:WEST WINFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13491-1712
Mailing Address - Country:US
Mailing Address - Phone:315-822-6646
Mailing Address - Fax:315-822-5407
Practice Address - Street 1:754 FORKS RD
Practice Address - Street 2:
Practice Address - City:WEST WINFIELD
Practice Address - State:NY
Practice Address - Zip Code:13491-1712
Practice Address - Country:US
Practice Address - Phone:315-822-6646
Practice Address - Fax:315-822-5407
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2010-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY125377-1204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine