Healthcare Provider Details

I. General information

NPI: 1942895818
Provider Name (Legal Business Name): MR. PHILLIP BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19511 WIED RD STE C
SPRING TX
77388-4589
US

IV. Provider business mailing address

19511 WIED RD STE C
SPRING TX
77388-4589
US

V. Phone/Fax

Practice location:
  • Phone: 346-382-3016
  • Fax:
Mailing address:
  • Phone: 346-382-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: