Individual
DR. BRIAN WIBOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5143 TILDENS GROVE BLVD, WINDERMERE, FL 34786-5702
(407) 656-9908
(407) 656-9908
Mailing address
5143 TILDENS GROVE BLVD, WINDERMERE, FL 34786-5702
(407) 656-9908
(407) 656-9908
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS0008848
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267324000
—
FL
01
—
71049
BCBS
FL
Enumeration date
03/08/2006
Last updated
03/23/2012
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