Healthcare Provider Details

I. General information

NPI: 1508974395
Provider Name (Legal Business Name): JIMMY J BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0004
US

IV. Provider business mailing address

PO BOX 100264
GAINESVILLE FL
32610-0264
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5199
  • Fax: 352-392-6781
Mailing address:
  • Phone: 352-273-5199
  • Fax: 352-392-6781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG67891
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number040328
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME131217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: