Healthcare Provider Details

I. General information

NPI: 1962636993
Provider Name (Legal Business Name): BENJAMIN JACOB BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E GOVERNMENT ST
PENSACOLA FL
32502
US

IV. Provider business mailing address

600 E GOVERNMENT ST
PENSACOLA FL
32502-6136
US

V. Phone/Fax

Practice location:
  • Phone: 850-500-7527
  • Fax: 850-855-4030
Mailing address:
  • Phone: 850-500-7527
  • Fax: 850-855-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME 122557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: