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NPI Code Detail

MEDICARE: DR. ROGER C BRAINARD M.D

MEDICARE:  DR. ROGER C BRAINARD  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
1174400000XSpecialistME34885FL

General Provider Information

NPI Number : 1467450338
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER C BRAINARD M.D
Provider Business Mailing Address
First Line : 3006 W AZEELE ST
Second Line :
City : TAMPA
State : FL
Zip : 33609-3139
Country : US
Telephone Number : 813-874-3006
Fax Number : 813-876-6258
Provider Business Practice Location Address
First Line : 3006 W AZEELE ST
Second Line :
City : TAMPA
State : FL
Zip : 33609-3139
Country : US
Telephone Number : 813-874-3006
Fax Number : 813-876-6258
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 05/12/2011

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Directions to “ DR. ROGER C BRAINARD M.D” Practice Location

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