Provider Demographics
NPI:1134120827
Name:BRITO, OMAR JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:JOSE
Last Name:BRITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2334 SW 130TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2657
Mailing Address - Country:US
Mailing Address - Phone:954-499-7609
Mailing Address - Fax:954-450-2017
Practice Address - Street 1:6517 TAFT ST
Practice Address - Street 2:SUITE 2007
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4048
Practice Address - Country:US
Practice Address - Phone:954-989-9825
Practice Address - Fax:954-989-9826
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 37203207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCO2910Medicare UPIN