Healthcare Provider Details

I. General information

NPI: 1598887010
Provider Name (Legal Business Name): JON ROBERT BROWN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SE GOLDTREE DR STE 103
PORT ST LUCIE FL
34952-7582
US

IV. Provider business mailing address

1400 SE GOLDTREE DR STE 103
PORT ST LUCIE FL
34952-7582
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-8446
  • Fax: 772-335-8499
Mailing address:
  • Phone: 772-335-8446
  • Fax: 772-335-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101016366
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number02004106A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS14288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: