Provider Demographics
NPI:1679620405
Name:BROWNWOOD M. D. ANESTHESIA
Entity Type:Organization
Organization Name:BROWNWOOD M. D. ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYDE
Authorized Official - Middle Name:DIRK
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:325-643-6100
Mailing Address - Street 1:2222 HIGHWAY 377 S
Mailing Address - Street 2:SUITE #11
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-3905
Mailing Address - Country:US
Mailing Address - Phone:325-643-6100
Mailing Address - Fax:325-646-9977
Practice Address - Street 1:2222 HIGHWAY 377 S
Practice Address - Street 2:SUITE #11
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-3905
Practice Address - Country:US
Practice Address - Phone:325-643-6100
Practice Address - Fax:325-646-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5616207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8047K0Medicare ID - Type UnspecifiedGROUP #K20V
TXG31599Medicare UPIN