Provider Demographics
NPI: | 1720182280 |
---|---|
Name: | BROWN, MARK CHRISTOPHER (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MARK |
Middle Name: | CHRISTOPHER |
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: | 5001 N PIEDRAS ST |
Mailing Address - Street 2: | EL PASO VA OUTPATIENT CLINIC, ATTN: CREDENTIALS OFFICE |
Mailing Address - City: | EL PASO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 79930-4210 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 915-564-6100 |
Mailing Address - Fax: | 915-564-6169 |
Practice Address - Street 1: | 5001 N PIEDRAS ST |
Practice Address - Street 2: | EL PASO VA OUTPATIENT CLINIC, ATTN: CREDENTIALS OFFICE |
Practice Address - City: | EL PASO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 79930-4210 |
Practice Address - Country: | US |
Practice Address - Phone: | 915-564-6100 |
Practice Address - Fax: | 915-564-6169 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-12 |
Last Update Date: | 2017-01-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
HI | 10344 | 2084P0800X, 2084P0804X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |