Provider Demographics
NPI:1235551755
Name:STEPHEN R. BROWN, M.D., PA
Entity Type:Organization
Organization Name:STEPHEN R. BROWN, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-792-6944
Mailing Address - Street 1:2006 MOORES LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1840
Mailing Address - Country:US
Mailing Address - Phone:903-792-6944
Mailing Address - Fax:903-792-6213
Practice Address - Street 1:2006 MOORES LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1840
Practice Address - Country:US
Practice Address - Phone:903-792-6944
Practice Address - Fax:903-792-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR80549Medicaid
TX00EZ54OtherMEDICARE ID
TX0330789-01Medicaid
TX0330789-01Medicaid