Provider Demographics
NPI:1043470040
Name:BROWN, JONATHAN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:THOMAS
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 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP0174207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-001OtherTRICARE
TX8CW707OtherBCBS
TX283578703Medicaid
TX750818167048OtherTRICARE
TX750818167015OtherTRICARE
TX8CX225OtherBCBS
TX75-0818167-044OtherTRICARE
TX75-2616977-028OtherTRICARE
TX283578701Medicaid
TX283578702Medicaid
TX283578704Medicaid
TX75-0818167-022OtherTRICARE
TX75-2616977-002OtherTRICARE
TX751976930005OtherTRICARE
TX8EZ186OtherBCBS
TX8EZ185OtherBCBS
TX8CX225OtherBCBS
TX283578701Medicaid
TXP00966733Medicare PIN
TX418857YMAFMedicare PIN
TXP00969640Medicare PIN