Wyatt James Brown, C.PED.

Primary specialty

SpecialistTaxonomy code 174400000X

License

0876099-5 Issued in OR

Practice address

16679 Boones Ferry Rd
Ste 215
Lake Oswego, OR 97035-4365

Phone

(503) 699-1911

Fax

(503) 699-1912

NPI assigned

Feb 8, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333411200000",
    "number": "1205976990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16679 BOONES FERRY RD STE 215",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354368",
            "telephone_number": "503-699-1911",
            "fax_number": "503-699-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16679 BOONES FERRY RD",
            "address_2": "STE 215",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354365",
            "telephone_number": "503-699-1911",
            "fax_number": "503-699-1912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "WYATT",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "C.PED.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2012-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "0876099-5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Lynn Brown, MSCN
• Mary Beth Brown, FNP
• Michael John Brown, RPH
• Sara Brown
• Shelley Wright Brown, MSW
• Geraldine Ruth Brownstein, MS LCSW
• Desiree Renee Bryant, LMT
• Kelsie Bryant
• Brooke Nicole Buckland, PA-C
• Marlo Bulza, DMD

• Specialist in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.