Healthcare Provider Details

I. General information

NPI: 1326083643
Provider Name (Legal Business Name): KENDALL P. BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 PINEBLUFF DR
DALLAS TX
75228-5841
US

IV. Provider business mailing address

2445 PINEBLUFF DR
DALLAS TX
75228-5841
US

V. Phone/Fax

Practice location:
  • Phone: 254-230-2095
  • Fax: 972-767-4744
Mailing address:
  • Phone: 254-230-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM9885
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberM9885
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License NumberM9885
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: