Provider Demographics
NPI:1801881222
Name:BRESTAN, ELMER P (MD)
Entity type:Individual
Prefix:
First Name:ELMER
Middle Name:P
Last Name:BRESTAN
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 1:4724 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2339
Mailing Address - Country:US
Mailing Address - Phone:850-696-4000
Mailing Address - Fax:850-444-7057
Practice Address - Street 1:4724 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2339
Practice Address - Country:US
Practice Address - Phone:850-696-4000
Practice Address - Fax:850-444-7057
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0015703207RH0003X
AL9306207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039662100Medicaid
FL17472YOtherMEDICARE PTAN
FL17472YOtherMEDICARE PTAN