MEDICARE: DR. OMAR JOSE BRITO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	ME 37203	FL

General Provider Information

NPI Number	:	1134120827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR JOSE BRITO MD

Provider Business Mailing Address
First Line	:	2334 SW 130TH TER
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-2657
Country	:	US
Telephone Number	:	954-499-7609
Fax Number	:	954-450-2017

Provider Business Practice Location Address
First Line	:	6517 TAFT ST
Second Line	:	SUITE 2007
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4048
Country	:	US
Telephone Number	:	954-989-9825
Fax Number	:	954-989-9826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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