MEDICARE: REGINALD BROWN JR.

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	251S00000X	Community/Behavioral Health Agency

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	:	1861140162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD BROWN JR.

Provider Business Mailing Address
First Line	:	2509 PEMBERTON CREEK DR
Second Line	:
City	:	SEFFNER
State	:	FL
Zip	:	33584-2407
Country	:	US
Telephone Number	:	813-716-8785
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 PEMBERTON CREEK DR
Second Line	:
City	:	SEFFNER
State	:	FL
Zip	:	33584-2407
Country	:	US
Telephone Number	:	813-716-8785
Fax Number	:

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

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/17/2022

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Directions to “ REGINALD BROWN JR. ” Practice Location

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