Provider Demographics
NPI:1831167956
Name:BROWN, RANDAL LANE (MD)
Entity type:Individual
Prefix:
First Name:RANDAL
Middle Name:LANE
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 1:6100 HARRIS PKWY STE 1240
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4248
Mailing Address - Country:US
Mailing Address - Phone:817-433-5155
Mailing Address - Fax:817-433-5177
Practice Address - Street 1:6100 HARRIS PKWY
Practice Address - Street 2:1240
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4101
Practice Address - Country:US
Practice Address - Phone:817-433-5155
Practice Address - Fax:817-433-5177
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068LMOtherBCBS
TX133644810Medicaid
TX043084505Medicaid
TX8U1322OtherBCBS
TX8U1322OtherBCBS
TX8D9286Medicare PIN
TXH04112Medicare UPIN