Provider Demographics
NPI:1528091725
Name:HEATH, BRYAN HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:HENRY
Last Name:HEATH
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist