Healthcare Provider Details

I. General information

NPI: 1144806779
Provider Name (Legal Business Name): CODY BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-4486
US

IV. Provider business mailing address

1147 NW 64TH TER NF GRADUATE MEDICAL EDUCATION BLDG
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-4541
  • Fax:
Mailing address:
  • Phone: 352-333-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS21317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: