Provider Demographics
NPI:1134301740
Name:BROWN, ALAN MARTIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:MARTIN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 N CAMPUS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6123
Mailing Address - Country:US
Mailing Address - Phone:989-839-6188
Mailing Address - Fax:989-839-6221
Practice Address - Street 1:4500 N CAMPUS RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6123
Practice Address - Country:US
Practice Address - Phone:989-839-6188
Practice Address - Fax:989-839-6221
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004591363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ63684Medicare UPIN