Provider Demographics
NPI:1225211352
Name:GREENBRIAR DERMATOLOGY, P.A.
Entity Type:Organization
Organization Name:GREENBRIAR DERMATOLOGY, P.A.
Other - Org Name:J. BRAD BOWDEN M.D., P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-522-7411
Mailing Address - Street 1:2211 NORFOLK
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4054
Mailing Address - Country:US
Mailing Address - Phone:713-522-7411
Mailing Address - Fax:713-522-7452
Practice Address - Street 1:2211 NORFOLK
Practice Address - Street 2:SUITE 405
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4054
Practice Address - Country:US
Practice Address - Phone:713-522-7411
Practice Address - Fax:713-522-7452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6065174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131854503Medicaid
TX0009RCOtherBCBS
TX8B6519Medicare UPIN
TX131854503Medicaid