Healthcare Provider Details

I. General information

NPI: 1497754303
Provider Name (Legal Business Name): ROLAND BRUTUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/11/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEMBROOK DR STE 300
ORLANDO FL
32810-6378
US

IV. Provider business mailing address

722 WEST COLONIAL DR
ORLANDO FL
32818
US

V. Phone/Fax

Practice location:
  • Phone: 321-200-4489
  • Fax: 407-554-5860
Mailing address:
  • Phone: 321-960-8209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD05924
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME83974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: