Basic Information
| Provider Information | |||||||||
| NPI: | 1033558895 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 E 32ND ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648042879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173477603 | ||||||||
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| Practice Location | |||||||||
| Address1: | 98 POPLAR ST | ||||||||
| Address2: | |||||||||
| City: | BLACKFOOT | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832211758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087822955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 56729 | CT | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 2013026513 | MO | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 10318440-1204 | UT | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | O-1042 | ID | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.