Provider Demographics
NPI:1427023449
Name:BROWN, BRIAN D (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:399-851-9252
Mailing Address - Fax:239-468-7929
Practice Address - Street 1:16420 HEALTHPARK COMMONS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9621
Practice Address - Country:US
Practice Address - Phone:239-985-1925
Practice Address - Fax:239-321-6044
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000440L363A00000X
PAMA003096L363A00000X
FLPA9106441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01318677OtherRR MEDICARE
FLP1015001OtherFREEDOM
FL004717800Medicaid
FL1097540OtherWELLCARE
FL7812955OtherAETNA
FL398573OtherAVMED
FLY0A80OtherBCBS OF FL
FLP953872OtherOPTIMUM
FL1097540OtherWELLCARE
FLP953872OtherOPTIMUM