Healthcare Provider Details

I. General information

NPI: 1609868702
Provider Name (Legal Business Name): WILLIAM BRENT KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 12/14/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 7TH ST 78 MDG/SGP FLIGHT MEDICINE
ROBINS AFB GA
31098-2227
US

IV. Provider business mailing address

78 MDG/SGPF 655 SEVENTH STREET
ROBINS AFB GA
31098
US

V. Phone/Fax

Practice location:
  • Phone: 478-327-7575
  • Fax:
Mailing address:
  • Phone: 478-327-7758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number055857
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number019083
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number055857
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number019083
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: