Provider Demographics
NPI:1194899641
Name:BRAUN, CONNIE J (MD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:J
Last Name:BRAUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5305
Mailing Address - Fax:352-616-0926
Practice Address - Street 1:3389 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-2461
Practice Address - Country:US
Practice Address - Phone:352-277-5462
Practice Address - Fax:352-691-5072
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME158305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME158305Medicaid
MI710897539OtherCOMMERCIAL
MI104726442Medicaid
MI104726442Medicaid
MIOP10410Medicare ID - Type UnspecifiedMEDICARE