Provider Demographics
NPI:1497779987
Name:BROWN, MICHAEL EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EVAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4530 E RAY RD
Mailing Address - Street 2:100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6094
Mailing Address - Country:US
Mailing Address - Phone:480-598-7500
Mailing Address - Fax:480-598-7510
Practice Address - Street 1:101 EAST HIGHWAY 260
Practice Address - Street 2:SUITE G
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541
Practice Address - Country:US
Practice Address - Phone:928-478-8905
Practice Address - Fax:928-478-8926
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ19685207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ410176Medicaid
AZZ120357Medicare PIN
AZ410176Medicaid