Healthcare Provider Details

I. General information

NPI: 1164484812
Provider Name (Legal Business Name): THOMAS S BREZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS S BREZA MDPA

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/12/2010
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 Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME0022052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: