Provider Demographics
NPI:1902064207
Name:CHESTER, BRENT (PHD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:CHESTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:7100 PINES BLVD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7355
Mailing Address - Country:US
Mailing Address - Phone:954-967-0107
Mailing Address - Fax:954-967-0109
Practice Address - Street 1:800 E CYPRESS CREEK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3522
Practice Address - Country:US
Practice Address - Phone:954-771-8903
Practice Address - Fax:954-771-8905
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory