Provider Demographics
NPI:1750589537
Name:LISE D. BROWN, DO, PA
Entity type:Organization
Organization Name:LISE D. BROWN, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-318-3386
Mailing Address - Street 1:3101 N FEDERAL HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1018
Mailing Address - Country:US
Mailing Address - Phone:954-318-3386
Mailing Address - Fax:
Practice Address - Street 1:3101 N FEDERAL HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1018
Practice Address - Country:US
Practice Address - Phone:954-318-3386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty