Provider Demographics
NPI:1730195835
Name:BROWN, GARY (CRNA)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 106002
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30348-6002
Mailing Address - Country:US
Mailing Address - Phone:352-867-8898
Mailing Address - Fax:352-732-6282
Practice Address - Street 1:2400 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1166
Practice Address - Country:US
Practice Address - Phone:866-389-4848
Practice Address - Fax:352-732-6282
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9227820367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306904400Medicaid
FLG3746OtherBLUE CROSS BLUE SHIELD
FLP00216189OtherRAILROAD MEDICARE
FL306904400Medicaid