Provider Demographics
NPI:1487919148
Name:BROWN, TYRONE MARTINEZ
Entity type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:MARTINEZ
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 SAPPHIRE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1491
Mailing Address - Country:US
Mailing Address - Phone:919-946-9772
Mailing Address - Fax:
Practice Address - Street 1:3100 SPRING FOREST RD #130
Practice Address - Street 2:AMERICAN ANESTHESIOLOGY
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616
Practice Address - Country:US
Practice Address - Phone:919-873-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNOT YET AVAILABLE367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered