Provider Demographics
NPI:1417303918
Name:AUSTELL, BRYCE (MD)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:AUSTELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRYCE
Other - Middle Name:T
Other - Last Name:AUSTELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:25 W CRYSTAL LAKE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4476
Mailing Address - Country:US
Mailing Address - Phone:407-254-2500
Mailing Address - Fax:407-423-2789
Practice Address - Street 1:45 W CRYSTAL LAKE ST STE 197
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4462
Practice Address - Country:US
Practice Address - Phone:407-254-2510
Practice Address - Fax:407-423-2789
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME148205207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program