MEDICARE: BREVARD CARDIOLOGY PHYSICIANS PA

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	207RC0000X	Cardiovascular Disease Physician		FL

General Provider Information

NPI Number	:	1275560716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREVARD CARDIOLOGY PHYSICIANS PA

Provider Business Mailing Address
First Line	:	150 N SYKES CREEK PKWY STE 300
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3488
Country	:	US
Telephone Number	:	321-452-3811
Fax Number	:	321-449-4573

Provider Business Practice Location Address
First Line	:	150 N SYKES CREEK PKWY STE 300
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3488
Country	:	US
Telephone Number	:	321-452-3811
Fax Number	:	321-449-4573

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD P MESSERSMITH
Credential	:	MD
Telephone Number	:	321-452-3811

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/22/2020

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