Healthcare Provider Details

I. General information

NPI: 1609955350
Provider Name (Legal Business Name): FREDERICK ANTHONY BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 RIVERSTONE BLVD STE. 103
MISSOURI CITY TX
77459-4377
US

IV. Provider business mailing address

4855 RIVERSTONE BLVD SUITE 103
MISSOURI CITY TX
77459-4377
US

V. Phone/Fax

Practice location:
  • Phone: 281-313-6348
  • Fax: 281-313-6349
Mailing address:
  • Phone: 281-313-6348
  • Fax: 281-313-6349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberL0994
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL0994
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: