MEDICARE: DR. BRIAN THOMAS BETHEA M.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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	D57533	MD
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME119970	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

General Provider Information

NPI Number	:	1417002908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN THOMAS BETHEA M.D.

Provider Business Mailing Address
First Line	:	4205 W ATLANTIC AVE
Second Line	:	BLDG B SUITE 201
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3901
Country	:	US
Telephone Number	:	561-638-9140
Fax Number	:	561-498-0320

Provider Business Practice Location Address
First Line	:	4205 W ATLANTIC AVE
Second Line	:	BLDG B SUITE 201
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3901
Country	:	US
Telephone Number	:	561-638-9140
Fax Number	:	561-498-0320

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	10/11/2016

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