Provider Demographics
NPI:1992815815
Name:BROWN, AMBUR L (MD)
Entity type:Individual
Prefix:DR
First Name:AMBUR
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMBUR
Other - Middle Name:L
Other - Last Name:STIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:209 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4267
Mailing Address - Country:US
Mailing Address - Phone:253-596-3300
Mailing Address - Fax:253-596-3301
Practice Address - Street 1:6487 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6104
Practice Address - Country:US
Practice Address - Phone:210-921-3800
Practice Address - Fax:210-881-9706
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4963207Q00000X, 207Q00000X
WAMD61337215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205217508Medicaid
TX318156YLPSOtherWELLMED MEDICARE
143106OtherBLUE CROSS MO
TX218133102OtherWELLMED MEDICAID
001013391Medicare PIN
TX318156YLPSOtherWELLMED MEDICARE
143106OtherBLUE CROSS MO
206050038Medicare PIN