Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MD-13652 | HI |
N | 208000000X | Pediatrician | MD-13652 | HI |
NPI | 1689765372 |
---|---|
Provider Name | Tyson Craig Brown |
First Address | Travis Afb, CA 94535-1809 |
Second Address | Travis Afb, CA 94535-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 17/12/2021 |