Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | K8609 | TX |
NPI | 1043279870 |
---|---|
Provider Name | Dr. Kenneth Joseph Brown |
First Address | Dallas, TX 75247-4228 |
Second Address | Plano, TX 75093-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 24/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165364401 | (05) | TX |
8B4321 | BCBSTX (01) | TX |
H21908 | (02) | TX |