Provider Demographics
NPI:1306113303
Name:BROWN, BRADLEY DUNCAN (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DUNCAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 S WESTMONTE DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4262
Mailing Address - Country:US
Mailing Address - Phone:407-774-1112
Mailing Address - Fax:
Practice Address - Street 1:237 S WESTMONTE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4262
Practice Address - Country:US
Practice Address - Phone:407-774-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111373207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009188700Medicaid