Provider Demographics
NPI:1295836765
Name:TIMOTHY M. BROWN, M.D., P.C.
Entity Type:Organization
Organization Name:TIMOTHY M. BROWN, M.D., P.C.
Other - Org Name:TIMOTHY M BROWN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MATHER
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-257-6393
Mailing Address - Street 1:12612 SE STARK STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1058
Mailing Address - Country:US
Mailing Address - Phone:503-257-6393
Mailing Address - Fax:503-287-8785
Practice Address - Street 1:12612 SE STARK STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1058
Practice Address - Country:US
Practice Address - Phone:503-257-6393
Practice Address - Fax:503-257-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X, 207ND0900X, 207NS0135X
ORMD12786207N00000X, 207NS0135X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000BHVCGMedicare PIN
ORC91053Medicare UPIN