Basic Information
| Provider Information | |||||||||
| NPI: | 1598781924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRITOS-BRAY | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | FERNANDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12470 TELECOM DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137796303 | ||||||||
| FaxNumber: | 8889771998 | ||||||||
| Practice Location | |||||||||
| Address1: | 12470 TELECOM DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137796303 | ||||||||
| FaxNumber: | 8889771998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME109247 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D64732 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | D64732 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | ME109247 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | D64732 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 208M00000X | ME109247 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RC0200X | ME109247 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 887377-03 & 04 | 01 | MD | BLUE CROSS/BLUE SHIELD - REGIONAL | OTHER | 020217200 | 05 | MD | MEDICAID | 887377-03 & 04 | 01 | MD | BLUE CROSS/BLUE SHIELD | OTHER |