MEDICARE: BRIAN MICHAEL JURBALA M.D.

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	207X00000X	Orthopaedic Surgery Physician	ME70116	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	200046088	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020593810	OTHER	FL	GROUP # FOR TRICARE
3	264652800	OTHER	FL	PROVIDER # FOR TRICARE

General Provider Information

NPI Number	:	1669468096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN MICHAEL JURBALA M.D.

Provider Business Mailing Address
First Line	:	3317 US HIGHWAY 98 S STE 9
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-8316
Country	:	US
Telephone Number	:	863-709-8777
Fax Number	:	863-709-1060

Provider Business Practice Location Address
First Line	:	3317 US HIGHWAY 98 S STE 9
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-8316
Country	:	US
Telephone Number	:	863-709-8777
Fax Number	:	863-709-1060

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	07/10/2024

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