Provider Demographics
NPI:1417075300
Name:KERBYSON, BRIAN J (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:KERBYSON
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 1:3434 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7094
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:2450 TAMIAMI TRL
Practice Address - Street 2:SUITE A
Practice Address - City:PT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-3922
Practice Address - Country:US
Practice Address - Phone:941-627-7204
Practice Address - Fax:941-627-6066
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10734208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146TYOtherFL BC
FLCM811YMedicare UPIN
FLBR885AMedicare PIN
FL146TYOtherFL BC
FLCM811WMedicare PIN
FLCM811XMedicare UPIN
FLBR885BMedicare PIN
FLCM811ZMedicare UPIN