Provider Demographics
NPI:1871595736
Name:BROWN, FARAH IAN (MD)
Entity type:Individual
Prefix:DR
First Name:FARAH
Middle Name:IAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 TAMARIND RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8608
Mailing Address - Country:US
Mailing Address - Phone:855-672-3888
Mailing Address - Fax:855-672-3888
Practice Address - Street 1:101 ALYCIA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2368
Practice Address - Country:US
Practice Address - Phone:855-672-3888
Practice Address - Fax:855-672-3888
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0421942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4324OtherMEDICARE GROUP NUMBER
GA000785661DMedicaid
GA30BDKGJMedicare ID - Type Unspecified
GA000785661DMedicaid