Basic Information
| Provider Information | |||||||||
| NPI: | 1831284405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4828 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504778109 | ||||||||
| FaxNumber: | 8504782412 | ||||||||
| Practice Location | |||||||||
| Address1: | 5147 N 9TH AVE STE 311 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504772597 | ||||||||
| FaxNumber: | 8504787941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP2945182 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 302744900 | 05 | FL | MEDICAID | 500006102 | 01 | RAILROAD MEDICARE | OTHER | Y015V | 01 | FL | BCBS OF FLORIDA | OTHER | 009906310 | 05 | AL | MEDICAID | 059001871 | 01 | AL | BCBS OF ALABAMA | OTHER |