Provider Demographics
NPI:1700881364
Name:BROWN, TERRY RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:RAY
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3217
Mailing Address - Country:US
Mailing Address - Phone:812-482-6066
Mailing Address - Fax:812-482-6201
Practice Address - Street 1:1025 1ST AVE W
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3217
Practice Address - Country:US
Practice Address - Phone:812-482-6066
Practice Address - Fax:812-482-6201
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027510207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100109570Medicaid
IN100109570Medicaid
INBR211320Medicare ID - Type Unspecified