Individual
TIMOTHY MATHER BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12612 SE STARK ST, PORTLAND, OR 97233-1058
(503) 257-6393
(503) 257-8785
Mailing address
12612 SE STARK ST, PORTLAND, OR 97233-1058
(503) 257-6393
(503) 257-8785
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD12786
OR
207ND0900X
Dermatopathology Physician
MD12786
OR
207NS0135X
Procedural Dermatology Physician
MD12786
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070008378
MEDICARE RAILROAD
—
Enumeration date
09/26/2006
Last updated
10/04/2013
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