Healthcare Provider Details

I. General information

NPI: 1134955073
Provider Name (Legal Business Name): BRIAN KEITH BROWN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4907 NW 43RD ST
GAINESVILLE FL
32606-2006
US

IV. Provider business mailing address

6517 NW 29TH ST
GAINESVILLE FL
32653-1443
US

V. Phone/Fax

Practice location:
  • Phone: 352-372-0047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-371184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: