Active NPI
Roger G Brown, MD
- Plastic and Reconstructive Surgery Physician
- Kalispell, MT
National Provider Identifier
1679659866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic and Reconstructive Surgery Physician
- License
- 4340
- Practice address
- 1297 Burns Way
Suite 1
Kalispell, MT 59901 - Phone
- (406) 752-1404
- Fax
- (406) 752-4263
- NPI assigned
- Oct 31, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic and Reconstructive Surgery Physician | 2086S0122X | 4340 | MT | Primary |
Addresses
Primary practice location
1297 Burns Way
Suite 1
Kalispell, MT 59901
Mailing address
1297 Burns Way
Suite 1
Kalispell, MT 59901
Phone (406) 752-1404
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 057642 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4340 | MT | MD | Plastic and Reconstructive Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679659866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1297 BURNS WAY",
"address_2": "SUITE 1",
"city": "KALISPELL",
"state": "MT",
"postal_code": "59901",
"telephone_number": "406-752-1404",
"fax_number": "406-752-4263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1297 BURNS WAY",
"address_2": "SUITE 1",
"city": "KALISPELL",
"state": "MT",
"postal_code": "59901",
"telephone_number": "406-752-1404",
"fax_number": "406-752-4263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "ROGER",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "MT",
"license": "4340",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "057642",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalispell, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.