Healthcare Provider Details

I. General information

NPI: 1992366371
Provider Name (Legal Business Name): KEITH BROWN JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 BIG BEND RD STE 206
RIVERVIEW FL
33578-7422
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-532-0002
  • Fax:
Mailing address:
  • Phone: 727-532-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS21870
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB11314600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MB11314600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: