Provider Demographics
NPI:1629058565
Name:SCHLAPPER, BRENT DAVIS (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DAVIS
Last Name:SCHLAPPER
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 1:151 VICTORIA COMMONS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7722
Mailing Address - Country:US
Mailing Address - Phone:386-740-4083
Mailing Address - Fax:386-736-1218
Practice Address - Street 1:151 VICTORIA COMMONS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7722
Practice Address - Country:US
Practice Address - Phone:386-740-4083
Practice Address - Fax:386-736-1218
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038143800Medicaid
FLOS0004023OtherSTATE MEDICAL LICENSE
FL080175531OtherRAILROAD MEDICARE NUMBER
FL0045OtherMEDICARE GROUP
FLK3258OtherMEDICARE GROUP NUMBER
FLE23556Medicare UPIN
FL82264WMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER