Provider Demographics
NPI:1568416873
Name:BROWN, THEODORE ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ROSS
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12039 NE 128TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3030
Practice Address - Country:US
Practice Address - Phone:425-899-5350
Practice Address - Fax:425-899-5355
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00030955208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8364887Medicaid
AKMD0955WMedicaid
WA7101702Medicaid
WAG8859998Medicare PIN
WA8364887Medicaid