Provider Demographics
NPI:1235465931
Name:BROWN, TRAVIS M (PA)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:M
Last Name:BROWN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:3955 PATIENT CARE DR
Mailing Address - Street 2:STE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4271
Mailing Address - Country:US
Mailing Address - Phone:517-908-0882
Mailing Address - Fax:517-908-0886
Practice Address - Street 1:505 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1266
Practice Address - Country:US
Practice Address - Phone:517-748-5500
Practice Address - Fax:517-780-9286
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2018-08-23
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Provider Licenses
StateLicense IDTaxonomies
MI5601005570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant