Provider Demographics
NPI:1144331497
Name:BROWN, BARRY D (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:D
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-543-5911
Mailing Address - Fax:314-543-5914
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-543-5911
Practice Address - Fax:314-543-5914
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201157013Medicaid
A11520Medicare UPIN
MO201157013Medicaid