Healthcare Provider Details

I. General information

NPI: 1215479241
Provider Name (Legal Business Name): MR. MICHAEL DAVID BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 CAMDEN ST STE 101
SAN ANTONIO TX
78215-2100
US

IV. Provider business mailing address

607 CAMDEN ST STE 101
SAN ANTONIO TX
78215-2100
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-3426
  • Fax: 726-203-4346
Mailing address:
  • Phone: 210-783-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10970
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: