Provider Demographics
NPI:1003110834
Name:BROWN, JUSTIN LEE (DPM)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 FOREST LN # 515057
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 E 6TH ST STE 104
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4537
Practice Address - Country:US
Practice Address - Phone:732-614-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2028213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EP635OtherTXBCBS
TX314881902Medicaid
TXP01388284OtherRAIL ROAD MEDICARE
TXP01388284OtherRAIL ROAD MEDICARE