Healthcare Provider Details

I. General information

NPI: 1447457296
Provider Name (Legal Business Name): ROBERT B BRYSKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CHILDRENS WAY NEMOURS CHILDRENS CLINIC, JACKSONVILLE
JACKSONVILLE FL
32207-8426
US

IV. Provider business mailing address

P.O. BOX 191
ROCKLAND DE
19723-0191
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-8275
  • Fax: 904-697-3927
Mailing address:
  • Phone: 302-651-4488
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200700638
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME100847
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME100847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: