Basic Information
Provider Information
NPI: 1033558895
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: RICHARD
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1105 E 32ND ST
Address2: SUITE 2
City: JOPLIN
State: MO
PostalCode: 648042879
CountryCode: US
TelephoneNumber: 4173477603
FaxNumber:  
Practice Location
Address1: 98 POPLAR ST
Address2:  
City: BLACKFOOT
State: ID
PostalCode: 832211758
CountryCode: US
TelephoneNumber: 2087822955
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/14/2013
LastUpdateDate: 11/30/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XO-1042IDY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2084P0800X10318440-1204UTN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2084P0800X2013026513MON Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2084P0800X56729CTN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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