Individual
BENITA ROYAL BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA03182
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
346642701 (MDACC)
—
TX
01
—
875N25
BC/BS#
TX
01
—
P00609140
RAILROAD MEDICARE
TX
01
—
P01090412
RAILROAD MEDICARE PTAN
TX
Enumeration date
03/02/2007
Last updated
09/11/2015
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