MEDICARE: DR. FARAH IAN BROWN MD

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	2085R0202X	Diagnostic Radiology Physician	042194	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GRP4324	OTHER	GA	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871595736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARAH IAN BROWN MD

Provider Business Mailing Address
First Line	:	1551 TAMARIND RD
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-8608
Country	:	US
Telephone Number	:	855-672-3888
Fax Number	:	855-672-3888

Provider Business Practice Location Address
First Line	:	101 ALYCIA DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2368
Country	:	US
Telephone Number	:	855-672-3888
Fax Number	:	855-672-3888

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/27/2019

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