Healthcare Provider Details

I. General information

NPI: 1316143068
Provider Name (Legal Business Name): DAVID C BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 VISTA REDONDA
SANTA FE NM
87506-9472
US

IV. Provider business mailing address

PO BOX 814
TESUQUE NM
87574-0814
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-3725
  • Fax: 505-989-9047
Mailing address:
  • Phone: 505-989-3725
  • Fax: 505-989-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number#96-21
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: