Provider Demographics
NPI:1790817286
Name:BRITTO, HECTOR (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:BRITTO
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:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:347-678-3164
Mailing Address - Fax:
Practice Address - Street 1:2211 BALSAN WAY
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6435
Practice Address - Country:US
Practice Address - Phone:347-678-3164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME766762084P0800X
MI43015062462084P0800X
WI21761-8752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267162000Medicaid
FLD58802Medicare UPIN
FL44536YMedicare ID - Type Unspecified