Healthcare Provider Details

I. General information

NPI: 1578096145
Provider Name (Legal Business Name): BROWN PLASTIC & RECONSTRUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17523 N DALE MABRY HWY
LUTZ FL
33548-4521
US

IV. Provider business mailing address

17523 N DALE MABRY HWY
LUTZ FL
33548-4521
US

V. Phone/Fax

Practice location:
  • Phone: 813-774-5733
  • Fax: 813-774-5619
Mailing address:
  • Phone: 813-774-5733
  • Fax: 813-774-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME123364
License Number StateFL

VIII. Authorized Official

Name: DR. JOSEPH MICHAEL BROWN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 908-601-4496