Provider Demographics
NPI:1104883834
Name:BRILL, ROBERT J SR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:BRILL
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:J
Other - Last Name:BRILL
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7826 SW 60TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476
Mailing Address - Country:US
Mailing Address - Phone:352-622-1377
Mailing Address - Fax:352-629-4812
Practice Address - Street 1:7826 SW 60TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6426
Practice Address - Country:US
Practice Address - Phone:352-622-1377
Practice Address - Fax:352-629-4812
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43207174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064311400Medicaid
FLD54816Medicare UPIN
FL42210Medicare ID - Type Unspecified