Provider Demographics
NPI:1275560716
Name:BREVARD CARDIOLOGY PHYSICIANS PA
Entity Type:Organization
Organization Name:BREVARD CARDIOLOGY PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:MESSERSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-452-3811
Mailing Address - Street 1:150 N SYKES CREEK PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3488
Mailing Address - Country:US
Mailing Address - Phone:321-452-3811
Mailing Address - Fax:321-449-4573
Practice Address - Street 1:150 N SYKES CREEK PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3488
Practice Address - Country:US
Practice Address - Phone:321-452-3811
Practice Address - Fax:321-449-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40922Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER