Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME111373 | FL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | ME111373 | FL |
NPI | 1306113303 |
---|---|
Provider Name | Bradley Duncan Brown |
First Address | Altamonte Springs, FL 32714-4262 |
Second Address | Altamonte Springs, FL 32714-4262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2011 |
Last Update Date | 28/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009188700 | (05) | FL |