Healthcare Provider Details

I. General information

NPI: 1538273180
Provider Name (Legal Business Name): C. EDWARD BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

IV. Provider business mailing address

901 TURTLE CREEK DR
TYLER TX
75701-1947
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-3651
  • Fax: 903-594-2038
Mailing address:
  • Phone: 903-596-3651
  • Fax: 903-594-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF9246
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberF9246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: