MEDICARE: DR. BRIAR REPPENHAGEN HULL AU.D.

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	231H00000X	Audiologist	AY402	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	S1115	OTHER	FL	BLUECROSS BLUESHIELD
3	J0731	OTHER	FL	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1083741805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAR REPPENHAGEN HULL AU.D.

Provider Business Mailing Address
First Line	:	3020 COLLEGE AVE E
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-5220
Country	:	US
Telephone Number	:	813-645-5355
Fax Number	:	813-645-5355

Provider Business Practice Location Address
First Line	:	3020 COLLEGE AVE E
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-5220
Country	:	US
Telephone Number	:	813-645-5355
Fax Number	:	813-645-5355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	10/03/2011

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