Provider Demographics
NPI:1164427530
Name:THOMAS BROWN, ANGELA C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:C
Last Name:THOMAS BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:C
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:704 OLD MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2740
Mailing Address - Country:US
Mailing Address - Phone:936-539-4004
Mailing Address - Fax:
Practice Address - Street 1:704 OLD MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2740
Practice Address - Country:US
Practice Address - Phone:936-539-4004
Practice Address - Fax:936-539-3635
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046731802Medicaid
TX046731802Medicaid
TXG11622Medicare UPIN