Healthcare Provider Details

I. General information

NPI: 1518949320
Provider Name (Legal Business Name): GARY S BRANDWEIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21069 S MILITARY TRL
BOCA RATON FL
33486-1043
US

IV. Provider business mailing address

21069 S MILITARY TRL
BOCA RATON FL
33486-1043
US

V. Phone/Fax

Practice location:
  • Phone: 561-338-6897
  • Fax: 561-338-1797
Mailing address:
  • Phone: 561-338-6897
  • Fax: 561-338-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberOS6544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: