Provider Demographics
NPI:1255778361
Name:BROWER, JONATHAN P (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:BROWER
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 1:235 PLAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3241
Mailing Address - Country:US
Mailing Address - Phone:401-425-5232
Mailing Address - Fax:401-425-5334
Practice Address - Street 1:235 PLAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3241
Practice Address - Country:US
Practice Address - Phone:401-425-5232
Practice Address - Fax:401-425-5334
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA285530208200000X
RIMD17031208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty