Provider Demographics
NPI:1609955350
Name:BROWN, FREDERICK ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ANTHONY
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 RIVERSTONE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4377
Mailing Address - Country:US
Mailing Address - Phone:281-313-6348
Mailing Address - Fax:281-313-6349
Practice Address - Street 1:4855 RIVERSTONE BLVD
Practice Address - Street 2:STE. 103
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4377
Practice Address - Country:US
Practice Address - Phone:281-313-6348
Practice Address - Fax:281-313-6349
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0994207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1606931-01Medicaid
TXH33796Medicare UPIN
TX1606931-01Medicaid
TX8L14307Medicare PIN
TX8J4627Medicare PIN