Healthcare Provider Details

I. General information

NPI: 1760581383
Provider Name (Legal Business Name): SCOTT MARTIN BROWN DMS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8379 S MASON DR
NEWAYGO MI
49337-9140
US

IV. Provider business mailing address

2743 HENRY ST # 301
MUSKEGON MI
49441-3509
US

V. Phone/Fax

Practice location:
  • Phone: 231-403-5000
  • Fax:
Mailing address:
  • Phone: 231-571-6757
  • Fax: 231-769-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002665
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: