Jerry Lee Brown, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010567 Issued in WA

Practice address

181 E 1St Ave
Colville, WA 99114-2801

Phone

(509) 684-3736

Fax

(509) 684-3407

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1780609040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 E 1ST AVE",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142801",
            "telephone_number": "509-684-3736",
            "fax_number": "509-684-3407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 E 1ST AVE",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142801",
            "telephone_number": "509-684-3736",
            "fax_number": "509-684-3407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JERRY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5050836",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES ID #",
            "identifier": "0210275",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth K Broderick
• Carolyn Anne Brooks, RN
• Theresa Lynn Brooks
• Brown & Sorensen, PLLC
• Christopher J. S. Brown
• Holly Buche
• Sharon Ann Buchta
• Thomas Bucklew, P.T.
• Buena Vista Alf Operations, LLC
• Buena Vista Inc

• General Practice Dentistry in Colville, WA
• Providers in Colville, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.