Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VE0102X | Reproductive Endocrinologist | 048608 | GA |
Y | 207VE0102X | Reproductive Endocrinologist | ME80256 | FL |
NPI | 1558340182 |
---|---|
Provider Name | Dr. Samuel E Brown |
First Address | Jacksonville, FL 32256-9111 |
Second Address | Jacksonville, FL 32256-9111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 21/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021201900 | (05) | FL |