Healthcare Provider Details

I. General information

NPI: 1437579489
Provider Name (Legal Business Name): BRANDON MASI PARKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE # 215
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1800 NW 10TH AVE STE T215
MIAMI FL
33136-1018
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1180
  • Fax: 305-326-7065
Mailing address:
  • Phone: 305-585-1178
  • Fax: 305-326-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOS16235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: