Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD00041952 | WA |
NPI | 1043203771 |
---|---|
Provider Name | Dr. Daniel Mark Brown |
First Address | Olympia, WA 98502-8145 |
Second Address | Olympia, WA 98502-8145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 05/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1117993 | (05) | WA |
F24696 | (02) | TX |