Provider Demographics
NPI:1396958872
Name:NEIDERMAN, BRET JARED (MD)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:JARED
Last Name:NEIDERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 SOUTH ASHLEY DRIVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5318
Mailing Address - Country:US
Mailing Address - Phone:813-899-6220
Mailing Address - Fax:813-985-8006
Practice Address - Street 1:100 SOUTH ASHLEY DRIVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5318
Practice Address - Country:US
Practice Address - Phone:813-899-6220
Practice Address - Fax:813-985-8006
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2015-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN161722085R0202X
MI43010895942085R0202X
FLME1012532085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL'000709000Medicaid
FLAR595Medicare PIN