Basic Information
| Provider Information | |||||||||
| NPI: | 1497779987 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | EVAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4530 E RAY RD | ||||||||
| Address2: | 100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850446094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805987500 | ||||||||
| FaxNumber: | 4805987510 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 EAST HIGHWAY 260 | ||||||||
| Address2: | SUITE G | ||||||||
| City: | PAYSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284788905 | ||||||||
| FaxNumber: | 9284788926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 04/15/2008 | ||||||||
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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 | 207P00000X | 19685 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 19685 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 410176 | 05 | AZ | MEDICAID |