Individual
DR. DERYCK WINSTON SPENCER BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 MAIN STREET, DUSHORE, PA 18614-0417
(570) 928-8146
(570) 928-7488
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD066159L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017018700001
—
PA
05
—
01860782
—
NY
01
—
080176502
RR MEDICARE PIN
PA
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039778
MEDICARE GROUP
PA
01
—
GU040074
MEDICARE GROUP
PA
Enumeration date
02/14/2006
Last updated
03/03/2021
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