Provider Demographics
NPI:1043334642
Name:BROWN, JOHN HALLUM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HALLUM
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9622 WEBB CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220
Mailing Address - Country:US
Mailing Address - Phone:214-358-3601
Mailing Address - Fax:214-358-3639
Practice Address - Street 1:9622 WEBB CHAPEL RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220
Practice Address - Country:US
Practice Address - Phone:214-358-3601
Practice Address - Fax:214-358-3639
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092220501Medicaid
TX00M096Medicare ID - Type Unspecified
TX092220501Medicaid