Provider Demographics
NPI:1225063852
Name:STIFFLER, BRIAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:STIFFLER
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 1:3717 TURMAN LOOP
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7794
Mailing Address - Country:US
Mailing Address - Phone:813-907-0123
Mailing Address - Fax:813-907-5559
Practice Address - Street 1:3717 TURMAN LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7794
Practice Address - Country:US
Practice Address - Phone:813-907-0123
Practice Address - Fax:813-907-5559
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276248000Medicaid
FLU7898XMedicare PIN