Individual
DERRICK STEVEN BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 COMO AVE, SAINT PAUL, MN 55108-1460
(651) 641-6200
(651) 641-6295
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56495
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001-0105015
MEDICA
—
01
—
1659631372
BCBS
MN
05
—
1659631372
—
MN
01
—
P01224931
RR MEDICARE
—
Enumeration date
05/29/2012
Last updated
08/24/2021
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