Provider Demographics
NPI:1710986930
Name:BROWN, STEPHEN ROMEN (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROMEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:FL 6
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2713
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:2006 MOORES LANE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1840
Practice Address - Country:US
Practice Address - Phone:903-792-6944
Practice Address - Fax:903-792-6213
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG-6478207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033078902Medicaid
OK200966610AMedicaid
TX00EZ54Medicare ID - Type Unspecified