Provider Demographics
NPI:1972729226
Name:FLETCHER, BRIAN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:FLETCHER
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 1:951 NW 13TH ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2337
Mailing Address - Country:US
Mailing Address - Phone:561-447-9341
Mailing Address - Fax:561-447-4316
Practice Address - Street 1:951 NW 13TH ST STE 1D
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2337
Practice Address - Country:US
Practice Address - Phone:561-447-9341
Practice Address - Fax:561-447-4316
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1259412085R0202X
MO20120017482085R0202X
IA396632085R0202X
KS04-352062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200962070BMedicaid
KSP01094576OtherRR MEDICARE
KSP01074853OtherRR MEDICARE
MOP01119938OtherRR MEDICARE
KS200962070AMedicaid
MOP01119938OtherRR MEDICARE
KSP01094576OtherRR MEDICARE
KSP01074853OtherRR MEDICARE
KS110527012Medicare PIN
KS200962070AMedicaid