Provider Demographics
NPI:1649232885
Name:BROWN, ROBERT T (PAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:BROWN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-0577
Mailing Address - Country:US
Mailing Address - Phone:509-689-2517
Mailing Address - Fax:509-689-2086
Practice Address - Street 1:507 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-0507
Practice Address - Country:US
Practice Address - Phone:509-689-2517
Practice Address - Fax:509-689-2086
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003558363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA10003558OtherLICENSE NUMBER
WA8437626Medicaid
WAG8885131Medicare Oscar/Certification
WA8437626Medicaid