Provider Demographics
NPI:1548526924
Name:BRANT, GEORGE ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALAN
Last Name:BRANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 LAND O LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-3413
Mailing Address - Country:US
Mailing Address - Phone:813-553-5050
Mailing Address - Fax:
Practice Address - Street 1:5450 LAND O' LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAND O' LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639
Practice Address - Country:US
Practice Address - Phone:813-553-5050
Practice Address - Fax:813-563-6353
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14678207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology