MEDICARE: DR. THOMAS S BREZA MD

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	207ND0101X	MOHS-Micrographic Surgery Physician	ME0022052	FL

General Provider Information

NPI Number	:	1164484812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS S BREZA MD

Provider Business Mailing Address
First Line	:	4341 BOUGAINVILLA DR
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-5017
Country	:	US
Telephone Number	:	954-492-8866
Fax Number	:	954-337-8180

Provider Business Practice Location Address
First Line	:	4341 BOUGAINVILLA DR
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-5017
Country	:	US
Telephone Number	:	954-492-8866
Fax Number	:	954-337-8180

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	01/12/2010

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