Individual
DR. BRANDON I FAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MBA
Contact information
Practice address
16318 N DALE MABRY HWY, TAMPA, FL 33618-1341
(813) 576-0077
Mailing address
16318 N DALE MABRY HWY, TAMPA, FL 33618-1341
(813) 576-0077
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME115880
FL
2083S0010X
Sports Medicine (Preventive Medicine) Physician
ME115880
FL
208D00000X
General Practice Physician
ME115880
FL
390200000X
Student in an Organized Health Care Education/Training Program
TRN17983
FL
Other
Enumeration date
04/12/2011
Last updated
02/04/2023
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