=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407098031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYLE L. BROWN MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2009
-----------------------------------------------------
Last Update Date | 01/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3316 N UNIVERSITY DR STE C
-----------------------------------------------------
City | NACOGDOCHES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75965-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-559-0800
-----------------------------------------------------
Fax | 936-559-0803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4106 BELLE POINTE DR
-----------------------------------------------------
City | NACOGDOCHES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75965-4879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-816-2400
-----------------------------------------------------
Fax | 936-559-0800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LYLE L BROWN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 936-559-0800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------