Healthcare Provider Details

I. General information

NPI: 1255507935
Provider Name (Legal Business Name): BERNADETTE BROWN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

894 SUMMIT ST SUITE 108
ROUND ROCK TX
78664-4322
US

IV. Provider business mailing address

894 SUMMIT ST SUITE 108
ROUND ROCK TX
78664-4322
US

V. Phone/Fax

Practice location:
  • Phone: 512-255-6033
  • Fax: 512-255-1150
Mailing address:
  • Phone: 512-255-6033
  • Fax: 512-255-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF6480
License Number StateTX

VIII. Authorized Official

Name: JOANNA L ANDERSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 512-255-6033