Basic Information
| Provider Information | |||||||||
| NPI: | 1578592887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JOHN LEROY | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 W MILLER ST | ||||||||
| Address2: | |||||||||
| City: | DILLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780173818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309652003 | ||||||||
| FaxNumber: | 8309652049 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 W MILLER ST | ||||||||
| Address2: | |||||||||
| City: | DILLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780173818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309652003 | ||||||||
| FaxNumber: | 8309652049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363AM0700X | PA02132 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.