Provider Demographics
NPI:1326251752
Name:LEDBETTER, RENE BROWN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:BROWN
Last Name:LEDBETTER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:6 IPSWICH CIR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1746
Mailing Address - Country:US
Mailing Address - Phone:850-862-9478
Mailing Address - Fax:850-862-9478
Practice Address - Street 1:4021 S 700 E
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2192
Practice Address - Country:US
Practice Address - Phone:800-732-7176
Practice Address - Fax:801-284-6753
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FL45665207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D20793Medicare UPIN