Provider Demographics
NPI:1508928557
Name:BROWN, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:H6.106, SOUTH CAMPUS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9032
Mailing Address - Country:US
Mailing Address - Phone:214-648-3113
Mailing Address - Fax:214-648-7262
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:H6.106, SOUTH CAMPUS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9032
Practice Address - Country:US
Practice Address - Phone:214-648-3113
Practice Address - Fax:214-648-7262
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4536207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138141013Medicaid
TXD48022Medicare UPIN