MEDICARE: SJB MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1265624852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SJB MD PA

Provider Business Mailing Address
First Line	:	21 HOSPITAL DR
Second Line	:	SUITE 270
City	:	PALM COAST
State	:	FL
Zip	:	32164-2380
Country	:	US
Telephone Number	:	386-437-5959
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 HOSPITAL DR
Second Line	:	SUITE 270
City	:	PALM COAST
State	:	FL
Zip	:	32164-2380
Country	:	US
Telephone Number	:	386-437-5959
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN J BROWN
Credential	:	M.D.
Telephone Number	:	386-437-5959

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	09/10/2008

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Directions to “SJB MD PA ” Practice Location

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