Provider Demographics
NPI:1477191237
Name:BROWN, RONALD EDWIN (PA-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EDWIN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 CYPRESS POINT DR
Mailing Address - Street 2:
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058-3201
Mailing Address - Country:US
Mailing Address - Phone:405-821-6502
Mailing Address - Fax:
Practice Address - Street 1:1427 CYPRESS POINT DR
Practice Address - Street 2:
Practice Address - City:GUNTER
Practice Address - State:TX
Practice Address - Zip Code:75058-3201
Practice Address - Country:US
Practice Address - Phone:405-821-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3131363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical