Provider Demographics
NPI:1114259165
Name:THOMAS S BREZA MD PA
Entity Type:Organization
Organization Name:THOMAS S BREZA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JULIA
Authorized Official - Last Name:BREZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-492-8866
Mailing Address - Street 1:4341 BOUGAINVILLA DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5017
Mailing Address - Country:US
Mailing Address - Phone:954-792-8866
Mailing Address - Fax:954-337-8180
Practice Address - Street 1:4341 BOUGAINVILLA DR
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-5017
Practice Address - Country:US
Practice Address - Phone:954-792-8866
Practice Address - Fax:954-337-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0022052174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty