Organization
JOHN R. BRENT MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R BRENT M.D., P.A. (PRESIDENT)
(850) 796-3737
Entity
Organization
Contact information
Practice address
1032 MAR WALT DR, SUITE 220, FORT WALTON BEACH, FL 32547-6661
(850) 796-3737
(850) 796-3739
Mailing address
1032 MAR WALT DR, SUITE 220, FORT WALTON BEACH, FL 32547-6661
(850) 796-3737
(850) 796-3739
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME92355
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME92355
MEDICAL LICENSE
—
Enumeration date
10/16/2007
Last updated
01/15/2013
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