MEDICARE: DR. DEANDRE A BROWN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	N0664	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB100267	OTHER	TX	MEDICARE IND
3	TXB100266	OTHER	TX	MEDICARE
5	TXB136723	OTHER	TX	BAYLOR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8CG180	OTHER	TX	BCBS IND
4	0051TD	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1932300779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEANDRE A BROWN MD

Provider Business Mailing Address
First Line	:	PO BOX 543539
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-3539
Country	:	US
Telephone Number	:	214-870-8133
Fax Number	:

Provider Business Practice Location Address
First Line	:	7227 CANA
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6860
Country	:	US
Telephone Number	:	214-870-8133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	06/26/2015

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