Provider Demographics
NPI:1225275183
Name:IRELAND, BRIAN LOUIS (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LOUIS
Last Name:IRELAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 S PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4375
Mailing Address - Country:US
Mailing Address - Phone:321-773-2659
Mailing Address - Fax:321-773-2667
Practice Address - Street 1:1380 S PATRICK DR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4375
Practice Address - Country:US
Practice Address - Phone:321-773-2659
Practice Address - Fax:321-773-2667
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine