Provider Demographics
NPI:1407883358
Name:BROWN, CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
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:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1277
Mailing Address - Country:US
Mailing Address - Phone:787-737-2311
Mailing Address - Fax:
Practice Address - Street 1:32 CALLE RAFAEL LASA
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-3212
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:787-737-2311
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307386OtherAVMED
FL90541OtherBC BS OF FLORIDA
OK200023720AMedicaid
FL277713400Medicaid
FL90541OtherBC BS OF FLORIDA
OK244513203Medicare ID - Type Unspecified