MEDICARE: BRAD E. OREN, MD PA

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	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GS635A	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1225382674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAD E. OREN, MD PA

Provider Business Mailing Address
First Line	:	8198 S JOG RD
Second Line	:	SUITE 102A
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2900
Country	:	US
Telephone Number	:	561-433-0098
Fax Number	:	561-433-4775

Provider Business Practice Location Address
First Line	:	8198 S JOG RD
Second Line	:	SUITE 102
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-6900
Country	:	US
Telephone Number	:	561-433-0098
Fax Number	:	561-433-4775

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRAD E OREN
Credential	:	M.D.
Telephone Number	:	561-433-0098

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	01/22/2013

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