Basic Information
| Provider Information | |||||||||
| NPI: | 1952303125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KROLL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR | ||||||||
| Address2: | SUITE 100 ATTN:CREDENTIALING | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527990046 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 MEDICAL BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346090220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526860086 | ||||||||
| FaxNumber: | 3526842081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 01/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS8257 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 275850 | 01 | FL | AVMED | OTHER | 125038 | 01 | FL | HUMANA GOLD | OTHER | 21339 | 01 | FL | SOUTH CARE | OTHER | 7834405 | 01 | FL | CIGNA | OTHER | 000123073 | 01 | FL | HUMANA COMMERCIAL | OTHER | 080171894 | 01 | FL | RAILROAD MEDICARE | OTHER | 260907000 | 05 | FL | MEDICAID | 174935 | 01 | FL | WELLCARE | OTHER | 58681 | 01 | FL | BCBS OF FLORIDA | OTHER |