Provider Demographics
NPI:1245231885
Name:BROWN, WILLIAM RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RANDALL
Last Name:BROWN
Suffix:
Gender:M
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:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1325
Mailing Address - Country:US
Mailing Address - Phone:903-792-1292
Mailing Address - Fax:903-792-2051
Practice Address - Street 1:5508 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1822
Practice Address - Country:US
Practice Address - Phone:903-792-1292
Practice Address - Fax:903-792-2051
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG18622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103364901Medicaid
TX300032042OtherRAILROAD MEDICARE
TX751708760OtherEIN
TX82R610Medicare ID - Type Unspecified
TXD48012Medicare UPIN
TX103364901Medicaid