Provider Demographics
NPI:1780983429
Name:BROWN, MICHAEL LYNN (CFA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W GARZA ST
Mailing Address - Street 2:550 W. GARZA
Mailing Address - City:SLATON
Mailing Address - State:TX
Mailing Address - Zip Code:79364-3824
Mailing Address - Country:US
Mailing Address - Phone:806-241-6839
Mailing Address - Fax:
Practice Address - Street 1:203 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2012
Practice Address - Country:US
Practice Address - Phone:575-445-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109038246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant