Provider Demographics
NPI:1740204072
Name:BROWN, ETHAN TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:TODD
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1701 HERMANN DR UNIT 2105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7363
Mailing Address - Country:US
Mailing Address - Phone:713-874-1825
Mailing Address - Fax:281-540-7393
Practice Address - Street 1:18951 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4217
Practice Address - Country:US
Practice Address - Phone:281-540-6453
Practice Address - Fax:281-540-7393
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6355207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG20628Medicare UPIN
TX8384M1Medicare ID - Type Unspecified