Provider Demographics
NPI:1255316352
Name:BERMAN, BRIAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 AVENTURA BOULEVARD
Mailing Address - Street 2:S. 205
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-933-6716
Mailing Address - Fax:305-933-6720
Practice Address - Street 1:2925 AVENTURA BOULEVARD
Practice Address - Street 2:S. 205
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-933-6716
Practice Address - Fax:305-933-6720
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65221207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3712591-00Medicaid
FL18091Medicare ID - Type Unspecified
FL3712591-00Medicaid