Provider Demographics
NPI:1457663692
Name:BROWN, JONATHAN (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13020 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0925
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:813-558-6494
Practice Address - Street 1:4423 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8232
Practice Address - Country:US
Practice Address - Phone:727-527-5272
Practice Address - Fax:727-522-7412
Is Sole Proprietor?:No
Enumeration Date:2010-07-03
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA5079213E00000X
FLPO4485213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist