Provider Demographics
NPI:1952303125
Name:KROLL, BRIAN C (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:KROLL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:SUITE 100 ATTN:CREDENTIALING
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:120 MEDICAL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-0220
Practice Address - Country:US
Practice Address - Phone:352-686-0086
Practice Address - Fax:352-684-2081
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275850OtherAVMED
FL125038OtherHUMANA GOLD
FL21339OtherSOUTH CARE
FL7834405OtherCIGNA
FL000123073OtherHUMANA COMMERCIAL
FL080171894OtherRAILROAD MEDICARE
FL260907000Medicaid
FL174935OtherWELLCARE
FL58681OtherBCBS OF FLORIDA
FL58681ZMedicare PIN
FL275850OtherAVMED