Provider Demographics
NPI:1275308660
Name:BRIAN HAMZAVI MD, LLC
Entity Type:Organization
Organization Name:BRIAN HAMZAVI MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ORTHOPAEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-481-0901
Mailing Address - Street 1:3440 POSEIDON WAY
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-1840
Mailing Address - Country:US
Mailing Address - Phone:267-481-0901
Mailing Address - Fax:
Practice Address - Street 1:1091 PORT MALABAR BLVD NE STE 2
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5100
Practice Address - Country:US
Practice Address - Phone:267-481-0901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Single Specialty