1235551755 NPI number — STEPHEN R. BROWN, M.D., PA

Table of content: (NPI 1235551755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235551755 NPI number — STEPHEN R. BROWN, M.D., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN R. BROWN, M.D., PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235551755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2006 MOORES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-1840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-792-6944
Provider Business Mailing Address Fax Number:
903-792-6213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 MOORES LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-792-6944
Provider Business Practice Location Address Fax Number:
903-792-6213
Provider Enumeration Date:
01/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
903-792-6944

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 80549 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00EZ54 . This is a "MEDICARE ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0330789-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com