Healthcare Provider Details

I. General information

NPI: 1720031941
Provider Name (Legal Business Name): BRIAN KEITH HAMEROFF DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10875 PARK BLVD STE. C
SEMINOLE FL
33772
US

IV. Provider business mailing address

10863 PARK BLVD SUITE A
SEMINOLE FL
33772-5423
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6650
  • Fax: 727-398-6550
Mailing address:
  • Phone: 727-398-6650
  • Fax: 727-398-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 2900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: