Provider Demographics
NPI:1144399932
Name:ENDOCRINE SPECIALIST PA
Entity Type:Organization
Organization Name:ENDOCRINE SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRODIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-436-3666
Mailing Address - Street 1:730 GOODLETTE ROAD NORTH
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5618
Mailing Address - Country:US
Mailing Address - Phone:239-436-3666
Mailing Address - Fax:239-436-3678
Practice Address - Street 1:730 GOODLETTE ROAD NORTH
Practice Address - Street 2:SUITE 205
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5618
Practice Address - Country:US
Practice Address - Phone:239-436-3666
Practice Address - Fax:239-436-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73670207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
460002821OtherRR CARE
FL42327OtherBCBS
FL42327YMedicare ID - Type Unspecified
D89477Medicare UPIN
460002821OtherRR CARE