Healthcare Provider Details

I. General information

NPI: 1487919148
Provider Name (Legal Business Name): MR. TYRONE MARTINEZ BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SPRING FOREST RD #130 AMERICAN ANESTHESIOLOGY
RALEIGH NC
27616
US

IV. Provider business mailing address

2420 SAPPHIRE VALLEY DR
RALEIGH NC
27604-1491
US

V. Phone/Fax

Practice location:
  • Phone: 919-873-9533
  • Fax:
Mailing address:
  • Phone: 919-946-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNOT YET AVAILABLE
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: