Provider Demographics
NPI:1124184064
Name:RELL, BRIAN C (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:RELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 HEALTH PARK WAY STE 230
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5177
Mailing Address - Country:US
Mailing Address - Phone:941-256-9191
Mailing Address - Fax:941-355-2292
Practice Address - Street 1:6310 HEALTH PARK WAY
Practice Address - Street 2:SUITE 345
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-256-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2993213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO2993OtherFLORIDA LICENSE
FL591466615OtherTAX ID
FL340287800Medicaid
FL591466615OtherTAX ID
FLU90555Medicare UPIN
FLE74734Medicare UPIN
FL5489530001Medicare NSC