Provider Demographics
NPI:1366856403
Name:BRILEY, DENVER (DO)
Entity Type:Individual
Prefix:DR
First Name:DENVER
Middle Name:
Last Name:BRILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-6003
Mailing Address - Country:US
Mailing Address - Phone:727-347-2557
Mailing Address - Fax:727-345-8972
Practice Address - Street 1:3955 58TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709
Practice Address - Country:US
Practice Address - Phone:727-347-2557
Practice Address - Fax:727-345-8972
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016121207R00000X
CA20A16159207P00000X
FLOS15745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine