Provider Demographics
NPI:1447242748
Name:BROWN, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1495 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4501
Mailing Address - Country:US
Mailing Address - Phone:904-354-4488
Mailing Address - Fax:904-272-4097
Practice Address - Street 1:1495 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4491
Practice Address - Country:US
Practice Address - Phone:904-354-4488
Practice Address - Fax:904-272-4097
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME65630207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF80243Medicare UPIN
FL27270ZMedicare ID - Type Unspecified