Provider Demographics
NPI:1730439670
Name:BRIAN E. MCCARTHY, DPM,PA
Entity type:Organization
Organization Name:BRIAN E. MCCARTHY, DPM,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-597-0049
Mailing Address - Street 1:11349 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5404
Mailing Address - Country:US
Mailing Address - Phone:352-597-0049
Mailing Address - Fax:352-597-4333
Practice Address - Street 1:11349 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5404
Practice Address - Country:US
Practice Address - Phone:352-597-0049
Practice Address - Fax:352-597-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2296213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65276YMedicare PIN
FLGS442AMedicare PIN
FLT91139Medicare UPIN
FL65276Medicare PIN