Provider Demographics
NPI:1356340087
Name:BROWN, SAMUEL DEAN (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DEAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:226 SE DEBELL AVE
Mailing Address - Street 2:BLDG B
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2300
Mailing Address - Country:US
Mailing Address - Phone:918-331-1070
Mailing Address - Fax:918-331-1076
Practice Address - Street 1:226 SE DEBELL AVE
Practice Address - Street 2:BLDG. B
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2300
Practice Address - Country:US
Practice Address - Phone:918-331-1070
Practice Address - Fax:918-331-1076
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC60996Medicare UPIN