Provider Demographics
NPI:1225217474
Name:BRENT D. SCHLAPPER
Entity Type:Organization
Organization Name:BRENT D. SCHLAPPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:SCHLAPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-736-8110
Mailing Address - Street 1:1015 N STONE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0802
Mailing Address - Country:US
Mailing Address - Phone:386-736-8110
Mailing Address - Fax:386-738-9603
Practice Address - Street 1:1015 N STONE ST
Practice Address - Street 2:SUITE A
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0802
Practice Address - Country:US
Practice Address - Phone:386-736-8110
Practice Address - Fax:386-738-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3258OtherMEDICARE GROUP NUMBER
FLOS0004023OtherLICENSE
FLK3258OtherMEDICARE GROUP NUMBER
FLOS0004023OtherLICENSE