Provider Demographics
NPI:1255651394
Name:BRZEZICKI, GRZEGORZ KRZYSZTOF (MD)
Entity Type:Individual
Prefix:
First Name:GRZEGORZ
Middle Name:KRZYSZTOF
Last Name:BRZEZICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 UNIVERSITY BLVD S STE 415
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4299
Mailing Address - Country:US
Mailing Address - Phone:904-296-2522
Mailing Address - Fax:904-296-8173
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 415
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4299
Practice Address - Country:US
Practice Address - Phone:904-296-2522
Practice Address - Fax:904-296-8173
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130734207T00000X
VA0116022279390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program