Basic Information
| Provider Information | |||||||||
| NPI: | 1679587794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 WHITE OAK ST | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272034710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366251360 | ||||||||
| FaxNumber: | 3366251889 | ||||||||
| Practice Location | |||||||||
| Address1: | 197B NC HWY 42N | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366252560 | ||||||||
| FaxNumber: | 3366253152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 02/17/2010 | ||||||||
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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 | 207P00000X | 9500848 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89-18611 | 05 | NC | MEDICAID | C2373 | 01 | NC | MEDCOST | OTHER | 1091Q | 01 | NC | BCBS | OTHER |