Provider Demographics
NPI:1942289590
Name:BROWN, BERTRON (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTRON
Middle Name:
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 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:SUITE 420
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-835-2900
Practice Address - Fax:409-835-1350
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114736505Medicaid
TXP02601506OtherMCRR
TXP02601522OtherMCRR
TX114736504Medicaid
TX114736508Medicaid
TX1K1769OtherMEDICARE