Provider Demographics
NPI:1750344073
Name:BROWN, MARK ALAN
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 E BERT KOUNS INDUSTRIAL LOOP STE 120
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5741
Mailing Address - Country:US
Mailing Address - Phone:318-212-3738
Mailing Address - Fax:
Practice Address - Street 1:1811 E BERT KOUNS INDUSTRIAL LOOP STE 120
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5741
Practice Address - Country:US
Practice Address - Phone:318-212-3738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1571113Medicaid
LA1571113Medicaid
LA4A307Medicare ID - Type Unspecified