Provider Demographics
NPI:1730917469
Name:BROWN, LEVI DALE (CPRSS)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:DALE
Last Name:BROWN
Suffix:
Gender:M
Credentials:CPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10326 GREENBRIAR PKWY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7643
Mailing Address - Country:US
Mailing Address - Phone:405-759-3860
Mailing Address - Fax:405-378-2486
Practice Address - Street 1:10316 S BLACKWELDER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-5559
Practice Address - Country:US
Practice Address - Phone:405-986-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist