Provider Demographics
NPI:1831203207
Name:BROWN, ANDREA VERNELL (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:VERNELL
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 E. PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4019
Mailing Address - Country:US
Mailing Address - Phone:972-223-4420
Mailing Address - Fax:972-274-1167
Practice Address - Street 1:526 E PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4019
Practice Address - Country:US
Practice Address - Phone:972-223-4420
Practice Address - Fax:972-274-1167
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1779302F00000X, 302R00000X, 305R00000X, 305S00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1798340Medicaid
TX80Y944Medicare PIN
TX1798340Medicaid