Individual
DR. BRIAN J. COSTLEIGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1344 S APOLLO BLVD STE 103, MELBOURNE, FL 32901-3183
(321) 441-8915
(321) 294-4107
Mailing address
989 S ATLANTIC AVE, COCOA BEACH, FL 32931-2422
(302) 381-2381
(321) 724-0455
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
C1-0004563
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000675901
—
DE
01
—
P00293179
RRMEDICARE
—
Enumeration date
06/01/2005
Last updated
06/06/2024
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