Provider Demographics
NPI:1164515268
Name:BRASETH, NOEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:R
Last Name:BRASETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:BOX 100371
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3001
Mailing Address - Country:US
Mailing Address - Phone:352-265-8335
Mailing Address - Fax:352-733-0371
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-733-0477
Practice Address - Fax:352-733-0371
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78343207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256901900Medicaid
G79269Medicare UPIN
FL256901900Medicaid
46969ZMedicare PIN
FL46969PMedicare PIN