Doctor Name: | RUSSELL W BROWN |
NPI Number: | 1003920034 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 085002271 |
Business Practice Address: | 405 Rushing Dr Herrin, IL - 629483730 |
Business Phone Number: | 6189933300 |
Business Fax Number: | 6189976626 |
Mailing Address: | Po Box 1105, INDIANAPOLIS |
State: | IN |
Postal Code: | 462061105 |
Phone Number: | 6185495361 |
Fax Number: | 6185290568 |
NPI Enumeration Date: | 08/18/2006 |
NPI Last Update Date: | 10/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 085002271 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |