Provider Demographics
NPI:1992720049
Name:BROWN, STEFANIE RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:RENEE
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 1:1611 NW 12TH AVE
Mailing Address - Street 2:JMH CENTRAL 600D
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-5954
Mailing Address - Fax:305-585-7381
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:JMH CENTRAL 600D
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-5954
Practice Address - Fax:305-585-7381
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 103026207R00000X
FLME103026208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0006136-00Medicaid
FLBF686ZMedicare Oscar/Certification
FL0006136-00Medicaid