Provider Demographics
NPI:1124328786
Name:BRYAN H HEATH MD PA
Entity type:Organization
Organization Name:BRYAN H HEATH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-957-3891
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-0036
Mailing Address - Country:US
Mailing Address - Phone:386-957-3891
Mailing Address - Fax:386-957-3887
Practice Address - Street 1:308 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7136
Practice Address - Country:US
Practice Address - Phone:386-957-3891
Practice Address - Fax:386-957-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty