Provider Demographics
NPI:1780851980
Name:BROWN, LARAE COLEMAN (MD)
Entity Type:Individual
Prefix:
First Name:LARAE
Middle Name:COLEMAN
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 1:15255 MAX LEGGETT PKWY STE 4400
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7273
Mailing Address - Country:US
Mailing Address - Phone:904-427-8898
Mailing Address - Fax:904-383-1893
Practice Address - Street 1:15255 MAX LEGGETT PKWY STE 4400
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7273
Practice Address - Country:US
Practice Address - Phone:904-427-8898
Practice Address - Fax:904-383-1893
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN12325390200000X
FLME112367207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005839000Medicaid
GA003124700AMedicaid
GA003124700AMedicaid