Individual
ROGER E. BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2479
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8335
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28122783A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000475939
ANTHEM PROVIDER NUMBER
IN
05
—
200024320
—
IN
01
—
9425535
PHCS PID NUMBER
IN
Enumeration date
09/01/2005
Last updated
12/04/2008
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