Healthcare Provider Details

I. General information

NPI: 1811051444
Provider Name (Legal Business Name): CONRAD A. BROWN M.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 E BROADWAY RD STE 120
TEMPE AZ
85282-1510
US

IV. Provider business mailing address

12135 N 138TH WAY
SCOTTSDALE AZ
85259-3748
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax:
Mailing address:
  • Phone: 480-314-7737
  • Fax: 480-314-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12190
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: