Provider Demographics
NPI:1629288980
Name:ALINE BROWN M D P C
Entity Type:Organization
Organization Name:ALINE BROWN M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-945-4811
Mailing Address - Street 1:3400 NW EXPRESSWAY ST STE 410
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4491
Mailing Address - Country:US
Mailing Address - Phone:405-945-4811
Mailing Address - Fax:405-945-4812
Practice Address - Street 1:3400 NW EXPRESSWAY ST STE 410
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4491
Practice Address - Country:US
Practice Address - Phone:405-945-4811
Practice Address - Fax:405-945-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKD38651207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100105970AMedicaid
OKOKB0013Medicare PIN