Healthcare Provider Details

I. General information

NPI: 1093972804
Provider Name (Legal Business Name): ROBERT E. LEE BROWNING IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 LINDEN LN
LAKE WALES FL
33853-4342
US

IV. Provider business mailing address

423 LINDEN LN
LAKE WALES FL
33853-4342
US

V. Phone/Fax

Practice location:
  • Phone: 863-679-2707
  • Fax:
Mailing address:
  • Phone: 863-679-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTRN12464
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME115061
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME115061
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME115061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: