Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 29101 | CO |
NPI | 1003818790 |
---|---|
Provider Name | Michael W Brown |
First Address | Colorado Springs, CO 80907-5302 |
Second Address | Colorado Springs, CO 80907-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 18/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01291012 | (05) | CO |
D84092 | (02) | CO |