Provider Demographics
NPI:1922497999
Name:ROGER T. BRILL, MD,FACS,PA
Entity Type:Organization
Organization Name:ROGER T. BRILL, MD,FACS,PA
Other - Org Name:ROGER T. BRILL, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-7987
Mailing Address - Street 1:6520 NW 9TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4205
Mailing Address - Country:US
Mailing Address - Phone:352-331-7987
Mailing Address - Fax:352-331-2787
Practice Address - Street 1:6520 NW 9TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4205
Practice Address - Country:US
Practice Address - Phone:352-331-7987
Practice Address - Fax:352-331-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020528208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty