Provider Demographics
NPI:1588667158
Name:BROWN, PETER S (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:S
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:820 MONTGOMERY RD
Mailing Address - Street 2:STE 202
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4200
Mailing Address - Country:US
Mailing Address - Phone:940-549-7741
Mailing Address - Fax:855-615-3435
Practice Address - Street 1:820 MONTGOMERY RD STE 202
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4200
Practice Address - Country:US
Practice Address - Phone:940-549-7741
Practice Address - Fax:855-615-3435
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF7411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080188877OtherRAILROAD MEDICARE
TX8AJ156OtherBCBS
TX100083803Medicaid
TX100083803Medicaid
TXC13857Medicare UPIN