Healthcare Provider Details

I. General information

NPI: 1184120610
Provider Name (Legal Business Name): BRIAN MEDLIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 H C KELLEY RD
ORLANDO FL
32831-2518
US

IV. Provider business mailing address

13807 GUILDHALL CIR
ORLANDO FL
32828-8219
US

V. Phone/Fax

Practice location:
  • Phone: 407-207-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberOS15183
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS15183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: