Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 217647 | MA |
N | 111NI0900X | Internist | 217647 | MA |
Y | 207RP1001X | Pulmonary Disease | 6091250-1205 | UT |
NPI | 1013998947 |
---|---|
Provider Name | Dr. Samuel Morris Brown |
First Address | Charlestown, MA 02129-9142 |
Second Address | Murray, UT 84107-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 10/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2066670 | (05) | MA |
469260 | TUFTS HEALTH PLAN (01) | MA |
I09716 | (02) | |
J27626 | BCBS MA (01) | MA |