Provider Demographics
NPI:1265460273
Name:BROWN, DONNA JEAN (DPM)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE #160
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5959
Mailing Address - Country:US
Mailing Address - Phone:386-672-9797
Mailing Address - Fax:
Practice Address - Street 1:335 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE #160
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5959
Practice Address - Country:US
Practice Address - Phone:386-672-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2561213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU58769Medicare UPIN
FL65441Medicare ID - Type UnspecifiedPODIATRY