Provider Demographics
NPI:1376588020
Name:BRIONES, /LUIS ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:/LUIS
Middle Name:ROBERTO
Last Name:BRIONES
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 1:6740 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3903
Mailing Address - Country:US
Mailing Address - Phone:954-986-9855
Mailing Address - Fax:954-986-9828
Practice Address - Street 1:9877 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6164
Practice Address - Country:US
Practice Address - Phone:954-966-7911
Practice Address - Fax:954-966-3352
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049235208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50361Medicare UPIN
FL02150Medicare ID - Type Unspecified