Healthcare Provider Details

I. General information

NPI: 1164403515
Provider Name (Legal Business Name): RANDALL W. BROWN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD D7-6
GAINESVILLE FL
32610-0416
US

IV. Provider business mailing address

1600 SW ARCHER RD D7-6
GAINESVILLE FL
32610-0416
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6750
  • Fax: 352-392-7609
Mailing address:
  • Phone: 352-273-6750
  • Fax: 352-392-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN9996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: