Provider Demographics
NPI:1801102959
Name:BROWN, RENITA GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:RENITA
Middle Name:GAIL
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:130 ANISKA DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-9133
Mailing Address - Country:US
Mailing Address - Phone:256-613-2791
Mailing Address - Fax:256-613-2791
Practice Address - Street 1:1612 US HIGHWAY 78 W
Practice Address - Street 2:SUITE 100
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-4014
Practice Address - Country:US
Practice Address - Phone:256-835-4756
Practice Address - Fax:256-831-5736
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2019-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALMD30452207Q00000X
AL30452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL141373Medicaid
AL102I081484Medicare PIN