Provider Demographics
NPI:1518949320
Name:BRANDWEIN, GARY S (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:BRANDWEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21069 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1043
Mailing Address - Country:US
Mailing Address - Phone:561-338-6897
Mailing Address - Fax:561-338-1797
Practice Address - Street 1:21069 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1043
Practice Address - Country:US
Practice Address - Phone:561-338-6897
Practice Address - Fax:561-338-1797
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS6544204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF75710Medicare UPIN