Provider Demographics
NPI:1316918378
Name:BROWN, DAVID MARCUS (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARCUS
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 1:1310 WENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-7954
Mailing Address - Country:US
Mailing Address - Phone:719-475-0270
Mailing Address - Fax:719-475-0272
Practice Address - Street 1:3920 N UNION BLVD
Practice Address - Street 2:#160
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4907
Practice Address - Country:US
Practice Address - Phone:719-475-0270
Practice Address - Fax:719-475-0272
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33665208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01336650Medicaid
CO01336650Medicaid
D97245Medicare UPIN