MEDICARE: DR. JON BRILLMAN 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	2084N0400X	Neurology Physician	MD-010476-E	PA
2	2084N0400X	Neurology Physician	ME102388	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598765372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON BRILLMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-1290
Fax Number	:	239-343-4008

Provider Business Practice Location Address
First Line	:	13782 PLANTATION RD STE 201
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4462
Country	:	US
Telephone Number	:	239-343-1290
Fax Number	:	239-343-4008

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/24/2021

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Directions to “ DR. JON BRILLMAN MD” Practice Location

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