Provider Demographics
NPI:1699857037
Name:SCHWAM, BRIAN LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEWIS
Last Name:SCHWAM
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 1:12620-3 BEACH BLVD.
Mailing Address - Street 2:PMB 309
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7130
Mailing Address - Country:US
Mailing Address - Phone:904-356-2744
Mailing Address - Fax:904-355-5747
Practice Address - Street 1:1550 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4161
Practice Address - Country:US
Practice Address - Phone:904-356-2744
Practice Address - Fax:904-355-5747
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77040207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL872263OtherFIRST HEALTH
FL286425OtherAVMED
FL44656OtherBLUE CROSS / BLUE SHIELD
FL5963008OtherAETNA
FL3310214480002OtherCIGNA
FL2512361OtherGHI
FL44656OtherBLUE CROSS / BLUE SHIELD
FL2512361OtherGHI