MEDICARE: DR. MICHAEL EDWIN BROWN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	F3783	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84E554	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1295795565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL EDWIN BROWN MD

Provider Business Mailing Address
First Line	:	7859 WALNUT HILL LN
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75230-5605
Country	:	US
Telephone Number	:	214-369-7661
Fax Number	:	214-369-2328

Provider Business Practice Location Address
First Line	:	7859 WALNUT HILL LN
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75230-5605
Country	:	US
Telephone Number	:	214-369-7661
Fax Number	:	214-369-2328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	09/09/2016

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