Provider Demographics
NPI:1275556904
Name:BROWN, MARSHALL KEITH (DO)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:KEITH
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 1:520 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5257
Mailing Address - Country:US
Mailing Address - Phone:509-416-8849
Mailing Address - Fax:509-542-3059
Practice Address - Street 1:5304 ROAD 68
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8078
Practice Address - Country:US
Practice Address - Phone:509-543-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE229207Q00000X
SD7914207Q00000X
MTMT28430207Q00000X
WY9500A207Q00000X
IDO-0812207Q00000X
WAOP60488723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06908OtherBCBS
NE06908OtherBCBS