Healthcare Provider Details

I. General information

NPI: 1922497999
Provider Name (Legal Business Name): ROGER T. BRILL, MD,FACS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 NW 9TH BLVD
GAINESVILLE FL
32605-4205
US

IV. Provider business mailing address

6520 NW 9TH BLVD
GAINESVILLE FL
32605-4205
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-7987
  • Fax: 352-331-2787
Mailing address:
  • Phone: 352-331-7987
  • Fax: 352-331-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0020528
License Number StateFL

VIII. Authorized Official

Name: DR. ROGER THOMAS BRILL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 352-331-7987