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General NPI Number Information
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NPI Number | 1184993776
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Entity Type | Individual
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Provider Name | MATTHEW PHILLIP BRILL D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 07/13/2017
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Provider Practice Location Address
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Address Line | 5301 S CONGRESS AVE
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City | ATLANTIS
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State | FL
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Zip | 33462-1149
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Country | US
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Telephone | 561-601-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 S CONGRESS AVE
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City | ATLANTIS
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State | FL
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Zip | 33462-1149
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 5190
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | UO2767
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 39072
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OS14534
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License Number State | FL
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