Provider Demographics
NPI:1043216534
Name:MCQUEEN, BRENT RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:RANDALL
Last Name:MCQUEEN
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 1:22741 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6005
Mailing Address - Country:US
Mailing Address - Phone:281-319-4334
Mailing Address - Fax:281-319-4855
Practice Address - Street 1:22741 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6005
Practice Address - Country:US
Practice Address - Phone:281-319-4334
Practice Address - Fax:281-319-4855
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6587207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100731203Medicaid
TX100731205Medicaid
TX100731204Medicaid
TX8B1098Medicare ID - Type Unspecified
TX8B8226Medicare ID - Type Unspecified
TX8A8387Medicare ID - Type Unspecified
TX100731204Medicaid
G67365Medicare UPIN
TX100731203Medicaid