Provider Demographics
NPI:1780382044
Name:BROWN, TIMOTHY J
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 PARK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1917
Mailing Address - Country:US
Mailing Address - Phone:601-983-6943
Mailing Address - Fax:281-710-0719
Practice Address - Street 1:2703 PARK HILLS DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1917
Practice Address - Country:US
Practice Address - Phone:601-983-6943
Practice Address - Fax:281-710-0719
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46588738172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver