Healthcare Provider Details

I. General information

NPI: 1235600560
Provider Name (Legal Business Name): DAVID R BROWN, MD EAR, NOSE & THROAT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SAINT MICHAELS DR STE B104
SANTA FE NM
87505-7671
US

IV. Provider business mailing address

435 SAINT MICHAELS DR STE B104
SANTA FE NM
87505-7671
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-9945
  • Fax: 505-393-1166
Mailing address:
  • Phone: 505-820-9945
  • Fax: 844-218-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID RICHARD BROWN
Title or Position: PRESIDENT
Credential: MD
Phone: 505-820-9945