Provider Demographics
NPI:1952490153
Name:BROWN, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:MATTHEW
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6801 W 20TH ST
Mailing Address - Street 2:SUITE 101, ATTN:SUE PINCKNEY
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9637
Mailing Address - Country:US
Mailing Address - Phone:970-378-8000
Mailing Address - Fax:970-378-8088
Practice Address - Street 1:473 CASTLE PINES AVE STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-7859
Practice Address - Country:US
Practice Address - Phone:970-587-7881
Practice Address - Fax:970-587-7738
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46037207QA0000X, 207Q00000X
OK193530207QA0000X
MO2004029090207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88788814Medicaid
COCO40104Medicare PIN
CO88788814Medicaid
COC811145Medicare PIN