Provider Demographics
NPI:1326409947
Name:PRIEST, BRENTON JAMES (DO, MA)
Entity Type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:JAMES
Last Name:PRIEST
Suffix:
Gender:M
Credentials:DO, MA
Other - Prefix:
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Mailing Address - Street 1:1647 CRANLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4161
Mailing Address - Country:US
Mailing Address - Phone:580-917-3124
Mailing Address - Fax:
Practice Address - Street 1:1151 BLACKWOOD AVE STE 150
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4523
Practice Address - Country:US
Practice Address - Phone:407-297-3838
Practice Address - Fax:407-447-6046
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS15700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine