Healthcare Provider Details

I. General information

NPI: 1982700407
Provider Name (Legal Business Name): BRIAN SELIUS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 CLEVELAND AVE SUITE 709
FORT MEYERS FL
33901-5857
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-3831
  • Fax: 239-343-2301
Mailing address:
  • Phone: 239-343-3831
  • Fax: 239-343-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34005316
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS10364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: