Provider Demographics
NPI:1639377096
Name:PLANCHARD, BRIAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:PLANCHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 MAR WALT DR UNIT 200
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6637
Mailing Address - Country:US
Mailing Address - Phone:850-862-4001
Mailing Address - Fax:850-862-1612
Practice Address - Street 1:1034 MAR WALT DR UNIT 200
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6637
Practice Address - Country:US
Practice Address - Phone:850-862-4001
Practice Address - Fax:850-862-1612
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9883207W00000X
LAMD.202467207W00000X
FLME136778207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367688402OtherCSHCN
TX367688401Medicaid
TX554549YK00Medicare UPIN