Provider Demographics
NPI:1720031941
Name:HAMEROFF, BRIAN KEITH (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:HAMEROFF
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 1:10863 PARK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-5423
Mailing Address - Country:US
Mailing Address - Phone:727-398-6650
Mailing Address - Fax:727-398-6550
Practice Address - Street 1:10875 PARK BLVD
Practice Address - Street 2:STE. C
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772
Practice Address - Country:US
Practice Address - Phone:727-398-6650
Practice Address - Fax:727-398-6550
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340206100Medicaid
FLE5736ZMedicare ID - Type Unspecified
FLU85614Medicare UPIN
FL3980150001Medicare NSC