Provider Demographics
NPI:1235600941
Name:BROWN, TRUMOND R
Entity Type:Individual
Prefix:
First Name:TRUMOND
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 TERRY ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-4117
Mailing Address - Country:US
Mailing Address - Phone:682-772-3833
Mailing Address - Fax:
Practice Address - Street 1:2800 YOUREE DR STE 350A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3646
Practice Address - Country:US
Practice Address - Phone:318-210-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator