Provider Demographics
NPI:1508962093
Name:BROWN, ERIC YALE (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:YALE
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4679
Mailing Address - Country:US
Mailing Address - Phone:505-998-7400
Mailing Address - Fax:505-998-7741
Practice Address - Street 1:3821 MASTHEAD ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4679
Practice Address - Country:US
Practice Address - Phone:505-998-7400
Practice Address - Fax:505-998-7741
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029215207RN0300X
NMMD2021-0795207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010029215CT02OtherBCBS
CT110106385OtherRAILROAD MEDICARE
CT000129151Medicaid
CT2995993OtherCIGNA
CT1909308OtherUNITED HEALTHCARE
NM30351731Medicaid
CT4212887OtherAETNA
CTZP660OtherOXFORD
CT020845OtherHEALTHNET
CT485278OtherCONNECTICARE
CT485278OtherCONNECTICARE