Basic Information
| Provider Information | |||||||||
| NPI: | 1386752699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 WILLIAMS ST | ||||||||
| Address2: | |||||||||
| City: | WAXAHACHIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751653447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729383493 | ||||||||
| FaxNumber: | 9729375608 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 W JEFFERSON ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | WAXAHACHIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751652200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729383493 | ||||||||
| FaxNumber: | 9729375608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2006 | ||||||||
| LastUpdateDate: | 02/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | L2822 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 149332202 | 05 | TX | MEDICAID | 00229Z | 01 | TX | MEDICARE GROUP | OTHER |