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NPI Code Detail

MEDICARE: DR. BRIAN D SOUTHERN M.D.

MEDICARE: DR. BRIAN D SOUTHERN 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
1207R00000XInternal Medicine Physician35.094966OH
2207RP1001XPulmonary Disease Physician35-094966OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851509921
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN D SOUTHERN M.D.
Provider Business Mailing Address
First Line : 24701 EUCLID AVE
Second Line : 3RD FLOOR
City : EUCLID
State : OH
Zip : 44117-1714
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line : LAKESIDE BUILDING ROOM 3018
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-2562
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2007
Last Update Date : 09/25/2023

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