Basic Information
Provider Information
NPI: 1396729588
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARBY
FirstName: BRIAN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1700 S TAMIAMI TR
Address2:  
City: SARASOTA
State: FL
PostalCode: 34239
CountryCode: US
TelephoneNumber: 9419178507
FaxNumber:  
Practice Location
Address1: 1700 S TAMIAMI TR
Address2:  
City: SARASOTA
State: FL
PostalCode: 34239
CountryCode: US
TelephoneNumber: 9419178507
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/01/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XME41850FLY Allopathic & Osteopathic PhysiciansEmergency Medicine 

ID Information
IDTypeStateIssuerDescription
5840901FLBLUE CROSS BLUE SHEILDOTHER
P0007785301 RAILROAD MEDICAREOTHER


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