Provider Demographics
NPI:1659600120
Name:THOMAS STEPHEN BREZA JR MD PA
Entity Type:Organization
Organization Name:THOMAS STEPHEN BREZA JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BREZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-275-2554
Mailing Address - Street 1:4341 BOUGAINVILLA DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5017
Mailing Address - Country:US
Mailing Address - Phone:954-492-8866
Mailing Address - Fax:954-337-8180
Practice Address - Street 1:4341 BOUGAINVILLA DR
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-5017
Practice Address - Country:US
Practice Address - Phone:954-492-8866
Practice Address - Fax:954-337-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-13
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98101207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDM193AMedicare PIN