1902943988 NPI number — DR. LYNETTE MARDEL BROWN M.D., PH.D.

Table of content: DR. LYNETTE MARDEL BROWN M.D., PH.D. (NPI 1902943988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902943988 NPI number — DR. LYNETTE MARDEL BROWN M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
LYNETTE
Provider Middle Name:
MARDEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902943988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5121 S. COTTONWOOD SUITE 307
Provider Second Line Business Mailing Address:
INTERMOUNTAIN MEDICAL CENTER
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-507-3378
Provider Business Mailing Address Fax Number:
801-507-3375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5121 S. COTTONWOOD SUITE 307
Provider Second Line Business Practice Location Address:
INTERMOUNTAIN MEDICAL CENTER
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84157-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-507-3378
Provider Business Practice Location Address Fax Number:
801-507-3375
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  Z9987 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36798 . This is a "INTERMOUNTAIN MEDICAL CENTER PHYSICIAN ID CODE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: Z9987 . This is a "HOPKINS MD ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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