MEDICARE: BRENT CHESTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1003837956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENT CHESTER

Provider Business Mailing Address
First Line	:	7100 HOLLYWOOD BLVD
Second Line	:	SUITE 23
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-7355
Country	:	US
Telephone Number	:	954-967-0107
Fax Number	:	954-967-0109

Provider Business Practice Location Address
First Line	:	800 E CYPRESS CREEK RD
Second Line	:	SUITE 202
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33334-3522
Country	:	US
Telephone Number	:	954-771-8903
Fax Number	:	954-771-8905

Authorized Official
Title or Position	:	OWNER
Name	:	BRENT CHESTER
Credential	:	PHD
Telephone Number	:	954-771-8903

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	06/17/2008

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