Provider Demographics
NPI:1245212000
Name:NEUSTATER, BRETT R (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:R
Last Name:NEUSTATER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:16855 NE 2ND AVE
Mailing Address - Street 2:#202
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1744
Mailing Address - Country:US
Mailing Address - Phone:305-770-0062
Mailing Address - Fax:305-770-1060
Practice Address - Street 1:16855 NE 2ND AVE
Practice Address - Street 2:#202
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1744
Practice Address - Country:US
Practice Address - Phone:305-770-0062
Practice Address - Fax:305-770-1060
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0063308207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379506300Medicaid
FL379506300Medicaid
G23618Medicare UPIN