Provider Demographics
NPI:1740273341
Name:BROWN, WILLIAM R (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 CHAMBERLAIN LN
Mailing Address - Street 2:SUITE 249
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2156
Mailing Address - Country:US
Mailing Address - Phone:502-384-4024
Mailing Address - Fax:502-384-4025
Practice Address - Street 1:4642 CHAMBERLAIN LN
Practice Address - Street 2:SUITE 249
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2156
Practice Address - Country:US
Practice Address - Phone:502-384-4024
Practice Address - Fax:502-384-4025
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244109213ES0103X
KY00232213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200401-900AMedicaid
KY8000232200Medicaid
U66055Medicare UPIN
IN200401-900AMedicaid
KY480022374Medicare PIN
KY0393603Medicare PIN