MEDICARE: DR. LYNETTE MARDEL BROWN M.D., PH.D.

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	207RP1001X	Pulmonary Disease Physician	Z9987	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36798	OTHER	UT	INTERMOUNTAIN MEDICAL CENTER PHYSICIAN ID CODE
2	Z9987	OTHER	MD	HOPKINS MD ID#

General Provider Information

NPI Number	:	1902943988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNETTE MARDEL BROWN M.D., PH.D.

Provider Business Mailing Address
First Line	:	5121 S. COTTONWOOD SUITE 307
Second Line	:	INTERMOUNTAIN MEDICAL CENTER
City	:	MURRAY
State	:	UT
Zip	:	84157
Country	:	US
Telephone Number	:	801-507-3378
Fax Number	:	801-507-3375

Provider Business Practice Location Address
First Line	:	5121 S. COTTONWOOD SUITE 307
Second Line	:	INTERMOUNTAIN MEDICAL CENTER
City	:	MURRAY
State	:	UT
Zip	:	84157-7000
Country	:	US
Telephone Number	:	801-507-3378
Fax Number	:	801-507-3375

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	11/21/2008

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