Basic Information
| Provider Information | |||||||||
| NPI: | 1780983429 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | C.F.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 W GARZA ST | ||||||||
| Address2: | 550 W. GARZA | ||||||||
| City: | SLATON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793643824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062416839 | ||||||||
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| Practice Location | |||||||||
| Address1: | 203 HOSPITAL DR | ||||||||
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| City: | RATON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 877402012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754457700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2011 | ||||||||
| LastUpdateDate: | 03/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | 109038 | TX | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.