Provider Demographics
NPI:1275073017
Name:BROWN, KYLE (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NIGHTINGALE ROAD, EDWARDS AFB
Mailing Address - Street 2:
Mailing Address - City:EDWARDS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:93524
Mailing Address - Country:US
Mailing Address - Phone:760-486-9155
Mailing Address - Fax:
Practice Address - Street 1:30 NIGHTINGALE ROAD, EDWARDS AFB
Practice Address - Street 2:
Practice Address - City:EDWARDS AFB
Practice Address - State:CA
Practice Address - Zip Code:93524
Practice Address - Country:US
Practice Address - Phone:661-277-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A170992084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry