Provider Demographics
NPI:1609119734
Name:BROWN, ALAN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ROBERT
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 1:77 W FOREST AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1481
Mailing Address - Country:US
Mailing Address - Phone:928-214-3600
Mailing Address - Fax:928-214-3601
Practice Address - Street 1:77 W FOREST AVE STE 304
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1481
Practice Address - Country:US
Practice Address - Phone:928-214-3600
Practice Address - Fax:928-214-3601
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65109208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics