Provider Demographics
NPI:1205115052
Name:BRIAN J.DEONARINE, MD PA
Entity type:Organization
Organization Name:BRIAN J.DEONARINE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEONARINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-562-9923
Mailing Address - Street 1:1285 36TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4885
Mailing Address - Country:US
Mailing Address - Phone:772-562-9923
Mailing Address - Fax:877-635-0804
Practice Address - Street 1:1285 36TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4885
Practice Address - Country:US
Practice Address - Phone:772-562-9923
Practice Address - Fax:877-635-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072762207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060055374OtherMEDICARE RAILROAD
FL38042OtherBC/BS
FL060055374OtherMEDICARE RAILROAD
FLG45199Medicare UPIN