Provider Demographics
NPI:1497865083
Name:BROWN, JOHN WESLEY III (CTRS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WESLEY
Last Name:BROWN
Suffix:III
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 VETERANS AVE
Mailing Address - Street 2:11K
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-0810
Mailing Address - Country:US
Mailing Address - Phone:607-664-4467
Mailing Address - Fax:
Practice Address - Street 1:76 VETERANS AVE
Practice Address - Street 2:11K
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-0810
Practice Address - Country:US
Practice Address - Phone:607-664-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20308174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist