Basic Information
| Provider Information | |||||||||
| NPI: | 1306818612 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 N. MAGDALEN SQUARE | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705107645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378934452 | ||||||||
| FaxNumber: | 3378937870 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 N MAGDALEN SQ | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705104645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378934452 | ||||||||
| FaxNumber: | 3378937870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 16581 | LA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1331210 | 05 | LA | MEDICAID |