Provider Demographics
NPI:1073564555
Name:PACHMAYER, BRIAN S (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:PACHMAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:813-514-8891
Practice Address - Street 1:5130 SUNFOREST DR STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6327
Practice Address - Country:US
Practice Address - Phone:727-824-0780
Practice Address - Fax:813-514-8891
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078106207R00000X, 208M00000X
FLME128092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017869200Medicaid
OH2187459Medicaid
OH2187459Medicaid
OH4136455Medicare PIN
OH4136454Medicare PIN