Healthcare Provider Details

I. General information

NPI: 1396190898
Provider Name (Legal Business Name): MATTHEW BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BROTHER GEENEN WAY
SARASOTA FL
34236-7102
US

IV. Provider business mailing address

5000 WINDSOR PARK
SARASOTA FL
34235-2611
US

V. Phone/Fax

Practice location:
  • Phone: 941-556-3233
  • Fax: 941-955-8214
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19682
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: