Basic Information
Provider Information
NPI: 1134310436
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: DANIEL
MiddleName: ADRIAN
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 720006
Address2:  
City: NORMAN
State: OK
PostalCode: 730704006
CountryCode: US
TelephoneNumber: 4055333545
FaxNumber:  
Practice Location
Address1: 1815 W 6TH AVE
Address2:  
City: STILLWATER
State: OK
PostalCode: 740744202
CountryCode: US
TelephoneNumber: 4057437300
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2007
LastUpdateDate: 03/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X4620OKY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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