Provider Demographics
NPI:1649413378
Name:GARRIEL, BRENN ISIDRO (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRENN
Middle Name:ISIDRO
Last Name:GARRIEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 ICOT BLVD BLDG A
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3703
Mailing Address - Country:US
Mailing Address - Phone:727-796-6900
Mailing Address - Fax:727-669-8417
Practice Address - Street 1:13600 ICOT BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3703
Practice Address - Country:US
Practice Address - Phone:727-796-6900
Practice Address - Fax:727-669-8417
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3353213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008331800Medicaid