Provider Demographics
NPI:1710902911
Name:GARRUTO, BRYAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DAVID
Last Name:GARRUTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:B. DAVID
Other - Middle Name:
Other - Last Name:GARRUTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6739 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2522
Mailing Address - Country:US
Mailing Address - Phone:813-779-3338
Mailing Address - Fax:813-779-3318
Practice Address - Street 1:13904 N DALE MABRY HWY STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2446
Practice Address - Country:US
Practice Address - Phone:813-908-2020
Practice Address - Fax:813-908-2133
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91515207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME91515OtherSTATE MEDICAL LICENSE
FLP01197322OtherRR MEDICARE
NC2006-01089OtherSTATE LICENSE
NC2006-01089OtherSTATE LICENSE
FLDU277YMedicare PIN
NC2006-01089OtherSTATE LICENSE