Provider Demographics
NPI:1760581383
Name:BROWN, SCOTT MARTIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MARTIN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6822 WILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49415-8609
Mailing Address - Country:US
Mailing Address - Phone:231-260-1632
Mailing Address - Fax:
Practice Address - Street 1:811 E KENT RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-9791
Practice Address - Country:US
Practice Address - Phone:616-225-0202
Practice Address - Fax:616-225-0207
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002665363A00000X
NY012350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant