Healthcare Provider Details

I. General information

NPI: 1568623551
Provider Name (Legal Business Name): JEAN MARIE BROWN LY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 S TUTTLE AVE
SARASOTA FL
34239-6405
US

IV. Provider business mailing address

3570 S TUTTLE AVE
SARASOTA FL
34239-6405
US

V. Phone/Fax

Practice location:
  • Phone: 941-927-4888
  • Fax:
Mailing address:
  • Phone: 941-927-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME116920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: