Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | H9192 | TX |
NPI | 1093782401 |
---|---|
Provider Name | Dr. Raymond C Brown JR. |
First Address | Dallas, TX 75254-7565 |
Second Address | Arlington, TX 76012-2562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 15/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117858401 | (05) | TX |
G03092 | (02) | TX |