Provider Demographics
NPI:1023192929
Name:BROWN, ANGELETTA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELETTA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1602 ROCK PRAIRIE RD
Mailing Address - Street 2:SUITE #3300
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8306
Mailing Address - Country:US
Mailing Address - Phone:979-693-8100
Mailing Address - Fax:979-693-8110
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:SUITE #3300
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-693-8100
Practice Address - Fax:979-693-8110
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3780208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13832Medicare UPIN
TX00FG71Medicare ID - Type Unspecified