MEDICARE: MELVIN D BROWN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	PA2003-0007	NM
2	363A00000X	Physician Assistant	PA2003-0007	NM

General Provider Information

NPI Number	:	1053327783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN D BROWN PA-C

Provider Business Mailing Address
First Line	:	1648 ALAMEDA BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-8807
Country	:	US
Telephone Number	:	505-944-7508
Fax Number	:	505-998-6927

Provider Business Practice Location Address
First Line	:	1648 ALAMEDA BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-8807
Country	:	US
Telephone Number	:	505-944-7508
Fax Number	:	505-998-6927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/06/2013

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