Organization
BREVARD GERIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN POTOMSKI DO (OWNER)
(321) 446-5893
Entity
Organization
Contact information
Practice address
720 E NEW HAVEN AVE SUITE 11, MELBOURNE, FL 32901-5474
(321) 724-4545
(321) 728-4168
Mailing address
720 E NEW HAVEN AVE SUITE 11, MELBOURNE, FL 32901-5474
(321) 724-4545
(321) 728-4168
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067596200
—
FL
Enumeration date
08/01/2019
Last updated
08/01/2019
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