Provider Demographics
NPI:1316907108
Name:BROWN, REISHA F (MD)
Entity type:Individual
Prefix:
First Name:REISHA
Middle Name:F
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-658-3707
Mailing Address - Fax:
Practice Address - Street 1:1265 CREEKSIDE PKWY STE 208
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1954
Practice Address - Country:US
Practice Address - Phone:239-658-3000
Practice Address - Fax:392-591-9433
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94478208000000X
NJMA74371208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277815700Medicaid
FL93481OtherBCBS
FL277815700Medicaid