Provider Demographics
NPI:1043391808
Name:BROWN-GRAHAM, COLETTE K (MD)
Entity Type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:K
Last Name:BROWN-GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1397 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3188
Mailing Address - Country:US
Mailing Address - Phone:561-792-0050
Mailing Address - Fax:561-792-0048
Practice Address - Street 1:12955 PALMS WEST DR STE 101
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9212
Practice Address - Country:US
Practice Address - Phone:561-792-0050
Practice Address - Fax:561-792-0048
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL71561207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251039100Medicaid
FLF69824Medicare UPIN