Basic Information
| Provider Information | |||||||||
| NPI: | 1083692750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7500 VISCOUNT BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157905700 | ||||||||
| FaxNumber: | 9155953916 | ||||||||
| Practice Location | |||||||||
| Address1: | 6600 NORTH DESERT BLVD | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155212200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 12/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | H0236 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 133636403 | 05 | TX | MEDICAID |