Provider Demographics
NPI:1811193444
Name:BROWN, DREW JACQUES IV (MD)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:JACQUES
Last Name:BROWN
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N 11TH ST # 508
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4242
Mailing Address - Country:US
Mailing Address - Phone:813-358-3578
Mailing Address - Fax:
Practice Address - Street 1:2236 GREEN HEDGES WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8189
Practice Address - Country:US
Practice Address - Phone:813-358-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA322038207X00000X
HIMDR-5314207X00000X
FLME121959207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHZ050ZMedicare PIN