Provider Demographics
NPI:1578592887
Name:BROWN, JOHN LEROY (PA)
Entity Type:Individual
Prefix:
First Name:JOHN LEROY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W MILLER ST
Mailing Address - Street 2:
Mailing Address - City:DILLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78017-3818
Mailing Address - Country:US
Mailing Address - Phone:830-965-2003
Mailing Address - Fax:830-965-2049
Practice Address - Street 1:230 W MILLER ST
Practice Address - Street 2:
Practice Address - City:DILLEY
Practice Address - State:TX
Practice Address - Zip Code:78017-3818
Practice Address - Country:US
Practice Address - Phone:830-965-2003
Practice Address - Fax:830-965-2049
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02132363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical