Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | OS6544 | FL |
NPI | 1518949320 |
---|---|
Provider Name | Dr. Gary S Brandwein |
First Address | Boca Raton, FL 33486-1043 |
Second Address | Boca Raton, FL 33486-1043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 10/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F75710 | (02) | FL |