Basic Information
Provider Information
NPI: 1649615873
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: STEVEN
MiddleName: LEE
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 650 E INDIAN SCHOOL RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850121839
CountryCode: US
TelephoneNumber: 6022775551
FaxNumber: 6022006004
Practice Location
Address1: 2121 N 1700 W
Address2:  
City: LAYTON
State: UT
PostalCode: 84041
CountryCode: US
TelephoneNumber: 8017734840
FaxNumber: 8015258167
Other Information
ProviderEnumerationDate: 05/01/2013
LastUpdateDate: 10/12/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X10595794-1204UTY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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