Provider Demographics
NPI:1861659880
Name:BROWN MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:BROWN MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-577-7100
Mailing Address - Street 1:PO BOX 1592
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-1592
Mailing Address - Country:US
Mailing Address - Phone:903-577-7100
Mailing Address - Fax:903-577-7102
Practice Address - Street 1:2001 N JEFFERSON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2338
Practice Address - Country:US
Practice Address - Phone:903-577-7100
Practice Address - Fax:903-577-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7876207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071REOtherBCBS INDIVIDUAL
1932106150OtherINDIVIDUAL NPI
TX1903122Medicaid
TX0098RLOtherBCBS
NCG83000Medicare UPIN
TX1903122Medicaid