Individual
MARK R BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
442 STACHLER DR, ST HENRY, OH 45883-9582
(419) 678-2371
(419) 678-4783
Mailing address
442 STACHLER DR, P.O. BOX 308, ST HENRY, OH 45883-9582
(419) 678-2371
(419) 678-4783
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34 005329
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0234455
MEDICAID GROUP
OH
05
—
0931782
—
OH
01
—
9282991
MEDICARE GROUP
OH
Enumeration date
07/21/2005
Last updated
02/15/2008
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