Healthcare Provider Details

I. General information

NPI: 1114259165
Provider Name (Legal Business Name): THOMAS S BREZA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 BOUGAINVILLA DR
LAUDERDALE BY THE SEA FL
33308-5017
US

IV. Provider business mailing address

4341 BOUGAINVILLA DR
LAUDERDALE BY THE SEA FL
33308-5017
US

V. Phone/Fax

Practice location:
  • Phone: 954-792-8866
  • Fax: 954-337-8180
Mailing address:
  • Phone: 954-792-8866
  • Fax: 954-337-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0022052
License Number StateFL

VIII. Authorized Official

Name: MRS. CAROLYN JULIA BREZA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 954-492-8866