Basic Information
| Provider Information | |||||||||
| NPI: | 1396859435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | BERNADETTE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 894 SUMMIT ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786644322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122556033 | ||||||||
| FaxNumber: | 5122551150 | ||||||||
| Practice Location | |||||||||
| Address1: | 894 SUMMIT ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786644322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122556033 | ||||||||
| FaxNumber: | 5122551150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | F6480 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.