Healthcare Provider Details

I. General information

NPI: 1457663692
Provider Name (Legal Business Name): JONATHAN BROWN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2010
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 7TH ST S STE 450
ST PETERSBURG FL
33701-4741
US

IV. Provider business mailing address

5901 E FOWLER AVE STE 100
TEMPLE TERRACE FL
33617-2305
US

V. Phone/Fax

Practice location:
  • Phone: 727-527-5272
  • Fax:
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-558-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4485
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: