Provider Demographics
NPI:1902883507
Name:BROWN, DOUGLAS R (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 HOMESTEAD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-9283
Mailing Address - Country:US
Mailing Address - Phone:330-683-3966
Mailing Address - Fax:
Practice Address - Street 1:365 S CROWN HILL RD
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-9527
Practice Address - Country:US
Practice Address - Phone:330-682-3075
Practice Address - Fax:330-682-7454
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000127743OtherANTHEM
OHQ012547AOtherHOMETOWN HEALTH PLAN
OHQ012547AOtherHOMETOWN SECURE CARE
OH020488800OtherFEDERAL BLACK LUNG
OH000000180216OtherUNISON HEALTH PLAN
OH560OtherSUMMACARE
OH0284697Medicaid
OH341131413BOtherAULTCARE
OH734829OtherBUCKEYE HEALTH PLAN
OH080015795Medicare PIN
OH000000180216OtherUNISON HEALTH PLAN
OH560OtherSUMMACARE