Healthcare Provider Details

I. General information

NPI: 1851612683
Provider Name (Legal Business Name): JASON BRADLEY BRILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

SURG CO B 3D MEDICAL BN BOX 63038
MCBH KANEOHE BAY HI
96863
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-5312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2011-01265
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberR9578
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD-21438
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: