MEDICARE: HERBERT BROWN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA1632	FL

General Provider Information

NPI Number	:	1427042084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERBERT BROWN PA

Provider Business Mailing Address
First Line	:	3029 LAKE POINTE CIR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32505-1837
Country	:	US
Telephone Number	:	850-479-9832
Fax Number	:

Provider Business Practice Location Address
First Line	:	3029 LAKE POINTE CIR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32505-1837
Country	:	US
Telephone Number	:	850-479-9832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	02/03/2011

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