Healthcare Provider Details

I. General information

NPI: 1922448489
Provider Name (Legal Business Name): GRACE ELIZABETH BROWN, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4471 LONG PRAIRIE ROAD SUITE 100
FLOWER MOUND TX
75028
US

IV. Provider business mailing address

4471 LONG PRAIRIE ROAD SUITE 100
FLOWER MOUND TX
75028
US

V. Phone/Fax

Practice location:
  • Phone: 972-316-4555
  • Fax: 972-316-4550
Mailing address:
  • Phone: 972-316-4555
  • Fax: 972-316-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPS040
License Number StateTX

VIII. Authorized Official

Name: DR. GRACE ELIZABETH BROWN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-615-1900