Healthcare Provider Details

I. General information

NPI: 1790908796
Provider Name (Legal Business Name): BRIAN C CENTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATE AVE
PANAMA CITY FL
32405-4587
US

IV. Provider business mailing address

PO BOX 946205
ATLANTA GA
30394-6205
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0036
  • Fax: 850-763-0259
Mailing address:
  • Phone: 800-998-3450
  • Fax: 757-942-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number29354
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2007-01477
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME170118
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: