Provider Demographics
NPI:1174572762
Name:TRIBUNE BROWN, DORIS J (DO)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:J
Last Name:TRIBUNE BROWN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:J
Other - Last Name:TRIBUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-831-6883
Mailing Address - Fax:314-831-3716
Practice Address - Street 1:1225 GRAHAM RD
Practice Address - Street 2:SUITE 2320C
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8012
Practice Address - Country:US
Practice Address - Phone:314-831-6883
Practice Address - Fax:314-831-3716
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003004232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI12566Medicare UPIN