Provider Demographics
NPI:1093745713
Name:SPERRY, BRENT ALAN (DO)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ALAN
Last Name:SPERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2928
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2834
Mailing Address - Country:US
Mailing Address - Phone:305-434-3000
Mailing Address - Fax:305-434-1641
Practice Address - Street 1:91500 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2547
Practice Address - Country:US
Practice Address - Phone:305-434-3000
Practice Address - Fax:305-434-1641
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 3932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82356Medicare ID - Type Unspecified
E32217Medicare UPIN