Basic Information
| Provider Information | |||||||||
| NPI: | 1588628705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | GARLAND | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1616 N MAIN ST STE C | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767831827 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Practice Location | |||||||||
| Address1: | 1616 N MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767838123 | ||||||||
| FaxNumber: | 2767831820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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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 | 207Q00000X | 010135636 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 240903 | 01 | VA | ANTHEM BCBS | OTHER | 515407 | 01 | VA | SOUTHERN HEALTH | OTHER | 1513316 | 01 | VA | UMWA | OTHER | 519974 | 01 | VA | VALUE OPTIONS | OTHER |