Provider Demographics
NPI:1144216789
Name:BROWN, SANDRA L (MD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 SE 5TH TER
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4878
Mailing Address - Country:US
Mailing Address - Phone:352-795-8815
Mailing Address - Fax:352-564-1090
Practice Address - Street 1:700 SE 5TH TER
Practice Address - Street 2:SUITE 5
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4878
Practice Address - Country:US
Practice Address - Phone:352-795-8815
Practice Address - Fax:352-564-1090
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0066863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26159YMedicare ID - Type Unspecified
FLF92732Medicare UPIN