Provider Demographics
NPI:1942209283
Name:BELLOTTE, BRENT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WILLIAM
Last Name:BELLOTTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9325 GLADES ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOCA
Mailing Address - State:FL
Mailing Address - Zip Code:33434
Mailing Address - Country:US
Mailing Address - Phone:561-488-1001
Mailing Address - Fax:
Practice Address - Street 1:9325 GLADES RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3907
Practice Address - Country:US
Practice Address - Phone:561-488-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92938207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7281683OtherAETNA
FL0108909OtherGHI
FL201817723AOtherHUMANA
FL300438OtherAV MED
FL2764814 00Medicaid
FL63665OtherGREAT WEST
FL9396256OtherPHCS
FLME92938OtherAMERI PLAN
FLP3656087OtherOXFORD
FLPCS1492OtherPARTNER CARE
FL11021OtherDIMENSION
FL294278OtherAMERI GROUP
FL6290625OtherCIGNA
FLP00297975OtherRAIL ROAD MEDICARE
FL16021OtherBLUE CROSS BLUE SHIELD
FL08-00553OtherUNITED HEALTH CARE
FLME92938OtherAMERI PLAN
FL16021ZMedicare PIN