Provider Demographics
NPI:1760493506
Name:BROWN, KEVIN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
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:PO BOX 720541
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75372-0541
Mailing Address - Country:US
Mailing Address - Phone:214-457-1353
Mailing Address - Fax:
Practice Address - Street 1:4730 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4009
Practice Address - Country:US
Practice Address - Phone:940-552-9901
Practice Address - Fax:940-553-2512
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM34792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1992588-02Medicaid
TX1992588-02Medicaid