Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 2028 | TX |
NPI | 1003110834 |
---|---|
Provider Name | Justin Lee Brown |
First Address | Dallas, TX 75379-0049 |
Second Address | Midland, TX 79703-4822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2011 |
Last Update Date | 13/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
314881902 | (05) | TX |
8EP635 | TXBCBS (01) | TX |
P01388284 | RAIL ROAD MEDICARE (01) | TX |