Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 297824 | NY |
NPI | 1003132788 |
---|---|
Provider Name | Dr. Kevin Paul Brazill |
First Address | Rochester, NY 14623-2327 |
Second Address | Rochester, NY 14623-2327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2010 |
Last Update Date | 20/08/2019 |