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General NPI Number Information
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NPI Number | 1134384258
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Entity Type | Organization
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Legal Business Name | GEORGE O BRICK MD PA
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 425 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-5919
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Country | US
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Telephone | 813-685-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 425 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-5919
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Country | US
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Telephone | 813-685-1220
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Fax |
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Authorized Official
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Title or Position | OFC MANAGER
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Name | SUE C BRICK
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Credential |
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Telephone | 813-685-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0031731
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License Number State | FL
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