Provider Demographics
NPI:1326251208
Name:BROWN ADDISON, CANDICE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LYNN
Last Name:BROWN ADDISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2233 E GRAUWYLER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-3239
Mailing Address - Country:US
Mailing Address - Phone:972-659-1234
Mailing Address - Fax:972-223-2626
Practice Address - Street 1:2233 E GRAUWYLER RD STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-3239
Practice Address - Country:US
Practice Address - Phone:972-659-1234
Practice Address - Fax:972-223-2626
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066092A208D00000X
TXN7984208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice