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General NPI Number Information
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NPI Number | 1093489023
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Entity Type | Individual
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Provider Name | MARK ANTHONY BROWN
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Gender | Male
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 6810 SW 8TH ST
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-2513
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Country | US
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Telephone | 954-245-8031
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Fax |
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Provider Business Mailing Address
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Address Line | 6810 SW 8TH ST
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-2513
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Country | US
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Telephone | 954-245-8031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | B650541893850
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License Number State | FL
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