Provider Demographics
NPI:1437579489
Name:PARKER, BRANDON MASI (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MASI
Last Name:PARKER
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 1:1800 NW 10TH AVE STE T215
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1018
Mailing Address - Country:US
Mailing Address - Phone:305-585-1178
Mailing Address - Fax:305-326-7065
Practice Address - Street 1:1611 NW 12TH AVE # 215
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-1180
Practice Address - Fax:305-326-7065
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS162352086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program