Provider Demographics
NPI:1982659710
Name:PAVLAS, BRIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:PAVLAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 SW 64TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6105
Mailing Address - Country:US
Mailing Address - Phone:786-999-4840
Mailing Address - Fax:305-356-7150
Practice Address - Street 1:4821 SW 64TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6105
Practice Address - Country:US
Practice Address - Phone:786-999-4840
Practice Address - Fax:305-356-7150
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3232213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist