Healthcare Provider Details

I. General information

NPI: 1750393179
Provider Name (Legal Business Name): LARRY D BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7848 W IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34747-1729
US

IV. Provider business mailing address

4166 FALLWOOD CIR
ORLANDO FL
32812-7909
US

V. Phone/Fax

Practice location:
  • Phone: 407-397-7032
  • Fax: 407-397-4041
Mailing address:
  • Phone: 407-826-9937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 38110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: