MEDICARE: FREDRICK JAMES BROWN

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	106S00000X	Behavior Technician	RBT-18-63554	FL

General Provider Information

NPI Number	:	1528542321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDRICK JAMES BROWN

Provider Business Mailing Address
First Line	:	1034 EDGEWOOD AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-5343
Country	:	US
Telephone Number	:	904-503-0131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 EDGEWOOD AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-5343
Country	:	US
Telephone Number	:	904-503-0131
Fax Number	:

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

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2018

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Directions to “ FREDRICK JAMES BROWN ” Practice Location

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