Provider Demographics
NPI:1932300779
Name:BROWN, DEANDRE A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANDRE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 543539
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-3539
Mailing Address - Country:US
Mailing Address - Phone:214-870-8133
Mailing Address - Fax:
Practice Address - Street 1:7227 CANA
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6860
Practice Address - Country:US
Practice Address - Phone:214-870-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB100267OtherMEDICARE IND
TX8CG180OtherBCBS IND
TXTXB100266OtherMEDICARE
TX0051TDOtherBCBS
TXTXB136723OtherBAYLOR MEDICARE