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General NPI Number Information
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NPI Number | 1386091940
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Entity Type | Organization
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Legal Business Name | CLARK-BROWN FAMILY CARE ASSOCIATES, PA
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 2113 E MARTIN LUTHER KING JR BLVD SUITE 101
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City | AUSTIN
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State | TX
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Zip | 78702-1357
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Country | US
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Telephone | 512-391-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 2113 E MARTIN LUTHER KING JR BLVD SUITE 101
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City | AUSTIN
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State | TX
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Zip | 78702-1357
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Country | US
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Telephone | 512-391-9700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHERYL CLARK-BROWN
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Credential | M.D.
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Telephone | 512-423-9886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | L6830
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License Number State | TX
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