Provider Demographics
NPI:1720036098
Name:BROWN, KATHRYN LOUISE (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LOUISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6510
Mailing Address - Country:US
Mailing Address - Phone:602-824-4200
Mailing Address - Fax:602-824-4215
Practice Address - Street 1:325 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6510
Practice Address - Country:US
Practice Address - Phone:602-824-4200
Practice Address - Fax:602-824-4215
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2816208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146317Medicaid
AZ0852180OtherBLUE CROSS/BLUE SHIELD
AZ0852180OtherBLUE CROSS/BLUE SHIELD
29337Medicare ID - Type Unspecified