1922147933 NPI number — GREGORY E BROWN MD

Table of content: GREGORY E BROWN MD (NPI 1922147933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922147933 NPI number — GREGORY E BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
GREGORY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1922147933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4085 DE ZAVALA RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAVANO PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78249-2084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-558-6288
Provider Business Mailing Address Fax Number:
210-558-6289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4360 GRECO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78222-2725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-648-8200
Provider Business Practice Location Address Fax Number:
855-392-7988
Provider Enumeration Date:
02/06/2007

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: 207R00000X , with the licence number:  Q6397 , 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: Q6397 . This is a "TX LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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