Provider Demographics
NPI:1043203771
Name:BROWN, DANIEL MARK (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARK
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 1:402 BLACK HILLS LN SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8145
Mailing Address - Country:US
Mailing Address - Phone:360-943-9400
Mailing Address - Fax:360-956-3475
Practice Address - Street 1:402 BLACK HILLS LN SW
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8145
Practice Address - Country:US
Practice Address - Phone:360-943-9400
Practice Address - Fax:360-956-3475
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041952208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117993Medicaid
TXF24696Medicare UPIN
WA1117993Medicaid