Provider Demographics
NPI:1467864660
Name:BROWN, GARY O'RIAN (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:O'RIAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:4105 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8103
Practice Address - Country:US
Practice Address - Phone:954-276-5552
Practice Address - Fax:954-985-2295
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN20219207Q00000X
FLME129502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111330500Medicaid