Provider Demographics
NPI:1578761011
Name:BROWN, CALVIN CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:CHRISTOPHER
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6760 GOODMAN RD STE 125
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9893
Mailing Address - Country:US
Mailing Address - Phone:662-782-5404
Mailing Address - Fax:662-405-0345
Practice Address - Street 1:6760 GOODMAN RD STE 125
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-9893
Practice Address - Country:US
Practice Address - Phone:662-782-5404
Practice Address - Fax:662-405-0345
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7330207W00000X
TXP5039207W00000X
TNMD0000047139207W00000X
ARE7330207WX0107X
TN47139207WX0107X
MS21670207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1578761011Medicaid
MS03526827Medicaid
TN1525893Medicaid
TX323924601Medicaid
TNP00975599OtherPALMETTO RR MEDICARE
AR188120001Medicaid
MS03526827Medicaid
TN103I181970Medicare PIN
MO1578761011Medicaid
MS302I186478Medicare PIN