Basic Information
| Provider Information | |||||||||
| NPI: | 1487686515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 N 20TH ST | ||||||||
| Address2: | BLDG 3 | ||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347456271 | ||||||||
| FaxNumber: | 3347429879 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 N 20TH ST | ||||||||
| Address2: | BLDG 3 | ||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347456271 | ||||||||
| FaxNumber: | 3347429879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 208200000X | 00025548 | AL | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 51002544 | 01 | AL | BLUE CROSS-BLUE SHIELD | OTHER |