1922394287 NPI number — MR. ROY C. BROWN ATP, CRTS

Table of content: (NPI 1588617070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922394287 NPI number — MR. ROY C. BROWN ATP, CRTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
ROY
Provider Middle Name:
C.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATP, CRTS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922394287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1019 DALWORTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75149-4149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-288-2332
Provider Business Mailing Address Fax Number:
972-288-2332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1019 DALWORTH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75149-4149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-288-2332
Provider Business Practice Location Address Fax Number:
972-288-2332
Provider Enumeration Date:
06/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247200000X , with the licence number:  ATP5186 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007295 . This is a "NRRTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: ATP5186 . This is a "RESNA" identifier . This identifiers is of the category "OTHER".




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