Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | M-7121 | ID |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 8415 | MT |
NPI | 1124190855 |
---|---|
Provider Name | Maurice D Brown |
First Address | Driggs, ID 83422-5112 |
Second Address | Driggs, ID 83422-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 13/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0140675 | (05) | MT |
F18209 | (02) | MT |