Healthcare Provider Details

I. General information

NPI: 1417912080
Provider Name (Legal Business Name): LARRY EUGENE BROWNE M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL DR
LULING TX
78648-3213
US

IV. Provider business mailing address

63 PARK ROAD 11 N
GONZALES TX
78629-5182
US

V. Phone/Fax

Practice location:
  • Phone: 830-875-8475
  • Fax: 830-875-2054
Mailing address:
  • Phone: 830-875-8475
  • Fax: 830-875-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberE0410
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: