Healthcare Provider Details

I. General information

NPI: 1275560716
Provider Name (Legal Business Name): BREVARD CARDIOLOGY PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SYKES CREEK PKWY STE 300
MERRITT ISLAND FL
32953-3488
US

IV. Provider business mailing address

150 N SYKES CREEK PKWY STE 300
MERRITT ISLAND FL
32953-3488
US

V. Phone/Fax

Practice location:
  • Phone: 321-452-3811
  • Fax: 321-449-4573
Mailing address:
  • Phone: 321-452-3811
  • Fax: 321-449-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. DONALD P MESSERSMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 321-452-3811