Provider Demographics
NPI:1962636993
Name:BROWN, BENJAMIN JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JACOB
Last Name:BROWN
Suffix:
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 1:600 E GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6136
Mailing Address - Country:US
Mailing Address - Phone:850-500-7527
Mailing Address - Fax:850-855-4030
Practice Address - Street 1:600 E GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502
Practice Address - Country:US
Practice Address - Phone:850-500-7527
Practice Address - Fax:850-855-4030
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 122557208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery