Provider Demographics
NPI:1447294111
Name:BROWN, BRIAN LEE (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:12479 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0913
Mailing Address - Country:US
Mailing Address - Phone:813-972-4199
Mailing Address - Fax:813-972-5753
Practice Address - Street 1:1395 PINELLAS AVENUE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689
Practice Address - Country:US
Practice Address - Phone:727-942-5008
Practice Address - Fax:727-942-5121
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5248207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82988OtherBCBS OF FLORIDA
FL82988Medicare PIN
FL82988VMedicare PIN
FL82988OtherBCBS OF FLORIDA