Healthcare Provider Details

I. General information

NPI: 1912385071
Provider Name (Legal Business Name): GRAHAM BROWN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2015
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

200 W MAGNOLIA AVE STE 201
FORT WORTH TX
76104-7657
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-1100
  • Fax:
Mailing address:
  • Phone: 817-702-2977
  • Fax: 817-702-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberR4013
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS020106
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: