Provider Demographics
NPI:1811968555
Name:BROWN, KEVIN DOUGLAS (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DOUGLAS
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:PO BOX 4100
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-4100
Mailing Address - Country:US
Mailing Address - Phone:304-955-6200
Mailing Address - Fax:304-399-2526
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:400
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-525-6905
Practice Address - Fax:304-525-6154
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001001A213ES0103X
KY00282213ES0103X
WV10396213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1699732214OtherGROUP NPI
WV3810009292Medicaid
WVV05711Medicare UPIN
WV1699732214OtherGROUP NPI
V05711Medicare UPIN
WV3810009292Medicaid
WV0374350001Medicare NSC
OHBR4220361Medicare PIN