Provider Demographics
NPI:1407098031
Name:LYLE L. BROWN MD PA
Entity Type:Organization
Organization Name:LYLE L. BROWN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-559-0800
Mailing Address - Street 1:4106 BELLE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-4879
Mailing Address - Country:US
Mailing Address - Phone:903-816-2400
Mailing Address - Fax:936-559-0800
Practice Address - Street 1:3316 N UNIVERSITY DR STE C
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2607
Practice Address - Country:US
Practice Address - Phone:936-559-0800
Practice Address - Fax:936-559-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202036401Medicaid
TX0013SHOtherBLUE CROSS BLUE SHIELD
TXDO8153OtherRAILROAD MEDICARE
TX0013SHOtherBLUE CROSS BLUE SHIELD