Basic Information
| Provider Information | |||||||||
| NPI: | 1942286562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ABE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 651 1ST ST W | ||||||||
| Address2: | STE K | ||||||||
| City: | SONOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954767045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079383870 | ||||||||
| FaxNumber: | 7079383076 | ||||||||
| Practice Location | |||||||||
| Address1: | 651 1ST ST W | ||||||||
| Address2: | STE K | ||||||||
| City: | SONOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954767045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079383870 | ||||||||
| FaxNumber: | 7079383076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 02/25/2013 | ||||||||
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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 | 207X00000X | MD00025370 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | G88678 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0212264 | 01 | WA | LABOR & IND WA STATE | OTHER | P00336903 | 01 | RR MEDICARE | OTHER |