Basic Information
| Provider Information | |||||||||
| NPI: | 1306874276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ASHLEY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1088 BROWN AVE | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287861918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284562828 | ||||||||
| FaxNumber: | 8284568903 | ||||||||
| Practice Location | |||||||||
| Address1: | 1088 BROWN AVE | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287861918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284562828 | ||||||||
| FaxNumber: | 8284568903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 12/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35285 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0102892 | 01 | NC | UNITED HEALTH CARE | OTHER | 19187 | 01 | NC | BCBS OF NC | OTHER | C2594 | 01 | NC | MEDCOST | OTHER | 7919187 | 05 | NC | MEDICAID |