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Individual

MARY JANE BROWN

Active
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Individual

MARY JANE BROWN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
17307
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3029208
TN
01
3089721
STONES RIVER IPA
TN
01
4040140
BLUECROSS
TN
01
64028186
KY MEDICAID
TN
Enumeration date
06/23/2006
Last updated
06/10/2010
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