Individual
RUSSELL W BROWN II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(618) 519-9200
(618) 687-1859
Mailing address
109 CALIFORNIA ST, PO BOX 577, CARTERVILLE, IL 62918-0577
(618) 519-9200
(618) 985-4635
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085002271
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043448
HEALTH ALLIANCE
—
01
—
080129117
BCBS
—
01
—
10019630
RAILROAD MEDICARE
—
05
—
143870
—
IL
01
—
174143
HEALTH LINK
—
Enumeration date
08/18/2006
Last updated
07/21/2022
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