Provider Demographics
NPI:1891086021
Name:BROWN, BYRON ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:ELLIOTT
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 1:7019 N PENNCROSS WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5185
Mailing Address - Country:US
Mailing Address - Phone:208-884-3757
Mailing Address - Fax:
Practice Address - Street 1:7019 N PENNCROSS WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5185
Practice Address - Country:US
Practice Address - Phone:208-884-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine