Basic Information
| Provider Information | |||||||||
| NPI: | 1497753735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROWN ORTHOPAEDIC SURGERY & SPORTS MEDICINE CENTER, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 ATTAIN ST | ||||||||
| Address2: | |||||||||
| City: | FUQUAY VARINA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275261972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195613139 | ||||||||
| FaxNumber: | 9195579251 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 ATTAIN ST | ||||||||
| Address2: | |||||||||
| City: | FUQUAY VARINA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275261972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195613139 | ||||||||
| FaxNumber: | 9195579251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 11/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9108912677 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 200001043475 | NC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | 200001043475 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 89013UV | 05 | NC | MEDICAID | 013UV | 01 | NC | BC | OTHER |