Provider Demographics
NPI:1063481174
Name:BROWN, MADELINE MORGAN (MD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:MORGAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 SWALLOWS RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-6224
Mailing Address - Country:US
Mailing Address - Phone:267-259-4744
Mailing Address - Fax:
Practice Address - Street 1:2517 SWALLOWS RD
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-6224
Practice Address - Country:US
Practice Address - Phone:267-259-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57472777Medicaid
CO091828FB5Medicare Oscar/Certification
I31778Medicare UPIN
CO57472777Medicaid