Healthcare Provider Details

I. General information

NPI: 1962964767
Provider Name (Legal Business Name): JACKSON BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1852 HILLVIEW ST STE 301
SARASOTA FL
34239-3638
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-262-0400
  • Fax: 941-262-0410
Mailing address:
  • Phone: 941-917-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME174640
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: