Provider Demographics
NPI:1881606176
Name:BROWN, FREDERICK OWEN (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:OWEN
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:PO BOX 22432
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33742-2432
Mailing Address - Country:US
Mailing Address - Phone:727-528-0528
Mailing Address - Fax:727-823-9502
Practice Address - Street 1:2016 KANSAS AVE NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3432
Practice Address - Country:US
Practice Address - Phone:727-528-0528
Practice Address - Fax:727-823-9502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42843207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62476OtherBCBS
FL62476Medicare ID - Type Unspecified
D57463Medicare UPIN