Healthcare Provider Details

I. General information

NPI: 1881821312
Provider Name (Legal Business Name): KATHLEEN HAYES BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN MARY HAYES M.D.

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 PARKER BLVD. STE 101
PUEBLO CO
81008-2285
US

IV. Provider business mailing address

PO BOX 560825
DENVER CO
80256-0825
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-1544
  • Fax: 719-924-1592
Mailing address:
  • Phone: 719-595-7580
  • Fax: 719-545-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number56941
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125:056409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: