Provider Demographics
NPI:1639468028
Name:KINDLE, BRETT JEREMY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:JEREMY
Last Name:KINDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1040 GULF BREEZE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7809
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:850-916-3710
Practice Address - Street 1:1040 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7809
Practice Address - Country:US
Practice Address - Phone:850-916-3700
Practice Address - Fax:850-916-3710
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1243332081S0010X, 2081S0010X, 2081S0010X
MN55682208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017276200Medicaid
FLPFXAROtherBLUE CROSS BLUE SHIELD