Basic Information
Provider Information
NPI: 1700230026
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWNLEE
FirstName: ZACHARY
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 800 W MAGNOLIA AVE
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761044611
CountryCode: US
TelephoneNumber: 8177597000
FaxNumber: 8177597027
Practice Location
Address1: 11805 SOUTH FWY STE 201
Address2:  
City: BURLESON
State: TX
PostalCode: 760287220
CountryCode: US
TelephoneNumber: 8177597000
FaxNumber: 8177597027
Other Information
ProviderEnumerationDate: 04/22/2016
LastUpdateDate: 03/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001XT0731TXY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

No ID Information.


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