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General NPI Number Information
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NPI Number | 1801014253
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Entity Type | Organization
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Legal Business Name | BEACON HEAD AND NECK CLINIC, PA
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 120 MEDICAL BLVD STE 100
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City | SPRING HILL
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State | FL
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Zip | 34609-0221
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Country | US
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Telephone | 352-688-9282
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 917584
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City | ORLANDO
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State | FL
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Zip | 32891-7584
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TED W BROWN
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Credential |
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Telephone | 352-688-9282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 85915
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License Number State | FL
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