MEDICARE: JOEDRECKA S BROWN SPEIGHTS MD

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	207Q00000X	Family Medicine Physician	ME79415	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336199132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEDRECKA S BROWN SPEIGHTS MD

Provider Business Mailing Address
First Line	:	2911 ROBERTS AVE
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32310-5007
Country	:	US
Telephone Number	:	850-644-1543
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 ROBERTS AVENUE
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32310
Country	:	US
Telephone Number	:	850-644-1543
Fax Number	:	855-230-7421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/17/2023

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