Provider Demographics
NPI:1558334789
Name:PARMER, BRYAN (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:PARMER
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 1:2150 49TH ST N STE A
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5237
Mailing Address - Country:US
Mailing Address - Phone:727-828-1730
Mailing Address - Fax:727-828-1731
Practice Address - Street 1:2150 49TH ST N STE A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5237
Practice Address - Country:US
Practice Address - Phone:727-828-1730
Practice Address - Fax:727-828-1731
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265731700Medicaid
H79407Medicare UPIN
FL265731700Medicaid