Healthcare Provider Details

I. General information

NPI: 1871595736
Provider Name (Legal Business Name): FARAH IAN BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ALYCIA DR
RICHMOND KY
40475-2368
US

IV. Provider business mailing address

1551 TAMARIND RD
DAVENPORT FL
33896-8608
US

V. Phone/Fax

Practice location:
  • Phone: 855-672-3888
  • Fax: 855-672-3888
Mailing address:
  • Phone: 855-672-3888
  • Fax: 855-672-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number042194
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: