Provider Demographics
NPI:1457390163
Name:BROWN, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:LANEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75667-0155
Mailing Address - Country:US
Mailing Address - Phone:903-806-5335
Mailing Address - Fax:
Practice Address - Street 1:8429 FM 1798 W
Practice Address - Street 2:
Practice Address - City:LANEVILLE
Practice Address - State:TX
Practice Address - Zip Code:75667-9603
Practice Address - Country:US
Practice Address - Phone:903-806-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6354207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032KHOtherBLUE CROSS BLUE SHIELD
TX135018320Medicaid
TX135018317Medicaid
TX135018320Medicaid
TX00830PMedicare PIN
TX8B2518Medicare ID - Type Unspecified
TX930085379Medicare PIN