=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861541310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH A BROWN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2704 I ST NE
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98002-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-833-7444
-----------------------------------------------------
Fax | 253-833-0480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15121 NE 177TH DR
-----------------------------------------------------
City | WOODINVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98072-6251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-488-9023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD00024852
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------