Individual
BRAD BROYLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2018 TALLEY RD, LEESBURG, FL 34748-3426
(352) 315-7500
(352) 360-6582
Mailing address
PO BOX 491000, LEESBURG, FL 34749-1000
(352) 315-7500
(352) 360-6582
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME 0071307
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03386
BLUE CROSS BLUE SHIELD #
FL
05
—
263317500
—
FL
Enumeration date
04/17/2006
Last updated
03/07/2023
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