BRIAN JOHN FAZZONE MD
NPI 1639669690
Student in an Organized Health Care Education/Training Program in Gainesville, FL

Q: What is Brian Fazzone's NPI number?

The NPI number for Brian Fazzone is 1639669690. It was assigned to this individual provider in the NPPES registry on May 15, 2018.

Q: What is Brian Fazzone's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Brian Fazzone was last updated on May 15, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 15, 2018PECOS Enrolled

1515 SW ARCHER RD, GAINESVILLE, FL 32608(352) 265-0916 Get Directions Write a Review

NPPES record last updated: May 15, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Brian John Fazzone Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRIAN JOHN FAZZONE MD (NPI 1639669690) is an individual student in an organized health care education/training program in Gainesville, Florida and active in the NPI registry since May 2018. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1639669690

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameBRIAN JOHN FAZZONECredential: MD

Location Address1515 SW ARCHER RDGainesville, FL 32608-1134

Mailing Address1515 Sw Archer RdGainesville, FL 32608-1134

Phone(352) 265-0916

Sole ProprietorNo

Enumeration DateMay 15, 2018

✔ NPI 1639669690 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1515 SW ARCHER RD, Gainesville, FL 32608

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Brian John Fazzone Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MATTHEW EYNON RN

Registered Nurse (Critical Care Medicine)