Provider Demographics
NPI:1992939490
Name:DILTS, BRENT C (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:C
Last Name:DILTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1340 BROAD AVE
Mailing Address - Street 2:STE 450
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2460
Mailing Address - Country:US
Mailing Address - Phone:813-388-2948
Mailing Address - Fax:813-388-6827
Practice Address - Street 1:7550 N DALE MABRY HWY STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-388-2948
Practice Address - Fax:813-249-0821
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.205224207L00000X
FLME137791207LP2900X
MS23747207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology