Provider Demographics
NPI:1487767877
Name:BROWN, MARTHA EUGENIA (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:EUGENIA
Last Name:BROWN
Suffix:
Gender:F
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 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-5404
Mailing Address - Fax:352-265-5506
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-5404
Practice Address - Fax:352-265-5506
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME769782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258387900Medicaid
FL49798OtherBLUE CROSS BLUE SHIELD
FLB65246Medicare UPIN
FL258387900Medicaid
FL49798OtherBLUE CROSS BLUE SHIELD