Provider Demographics
NPI: | 1386638922 |
---|---|
Name: | DUBLIN, BRIAN K (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | BRIAN |
Middle Name: | K |
Last Name: | DUBLIN |
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: | 410 CELEBRATION PL STE 300 |
Mailing Address - Street 2: | |
Mailing Address - City: | CELEBRATION |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34747-5434 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 407-894-4474 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 410 CELEBRATION PL STE 300 |
Practice Address - Street 2: | |
Practice Address - City: | CELEBRATION |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34747-5434 |
Practice Address - Country: | US |
Practice Address - Phone: | 407-894-4474 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-09-09 |
Last Update Date: | 2023-02-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME82279 | 207RI0011X, 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
I35637 | Medicare UPIN | ||
FL | 07758Z | Medicare PIN | |
FL | 07758Y | Medicare PIN |