Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD00028042 | WA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD00028042 | WA |
NPI | 1164548244 |
---|---|
Provider Name | Dr. Michael C Brown |
First Address | Des Moines, WA 98198-6220 |
Second Address | Des Moines, WA 98198-6220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 29/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0193277 | WA LABOR & INDUSTRIES (01) | WA |
5208BR | WA BLUE SHEILD (01) | WA |
C35642 | (02) | WA |
P00225761 | RAILROAD (01) | WA |