Healthcare Provider Details

I. General information

NPI: 1275538944
Provider Name (Legal Business Name): JEREMY S BREIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CLINT MOORE RD SUITE 100
BOCA RATON FL
33487-2768
US

IV. Provider business mailing address

1601 CLINT MOORE RD SUITE 100
BOCA RATON FL
33487-2768
US

V. Phone/Fax

Practice location:
  • Phone: 561-939-0200
  • Fax: 561-939-0274
Mailing address:
  • Phone: 561-939-0200
  • Fax: 561-939-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME102846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: