Healthcare Provider Details

I. General information

NPI: 1346356094
Provider Name (Legal Business Name): DONALD C BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EAGLE ROCK AVE NE
ALBUQUERQUE NM
87122-4033
US

IV. Provider business mailing address

PO BOX 50579
ALBUQUERQUE NM
87181-0579
US

V. Phone/Fax

Practice location:
  • Phone: 505-797-1312
  • Fax: 505-797-1312
Mailing address:
  • Phone: 505-797-1312
  • Fax: 505-797-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2004-0078
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: