Provider Demographics
NPI:1942277694
Name:BRAHM, TYLER BURGESS (DPM)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:BURGESS
Last Name:BRAHM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:300 JEFFORDS ST
Mailing Address - Street 2:STE D
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3810
Mailing Address - Country:US
Mailing Address - Phone:727-446-2190
Mailing Address - Fax:727-446-3350
Practice Address - Street 1:300 JEFFORDS ST
Practice Address - Street 2:STE D
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3810
Practice Address - Country:US
Practice Address - Phone:727-446-2190
Practice Address - Fax:727-446-3350
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO922213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1942277694OtherNPI
FLT84646Medicare UPIN
FL0477670001Medicare NSC
FL33537Medicare PIN