Healthcare Provider Details

I. General information

NPI: 1659600120
Provider Name (Legal Business Name): THOMAS STEPHEN BREZA JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2009
Last Update Date: 09/27/2010
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: 954-492-8866
  • Fax: 954-337-8180
Mailing address:
  • Phone: 954-492-8866
  • Fax: 954-337-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME98101
License Number StateFL

VIII. Authorized Official

Name: DR. THOMAS STEPHEN BREZA JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 352-275-2554