Brad Broyles, MD | |
2018 Talley Rd, Leesburg, FL 34748-3426 | |
(352) 315-7500 | |
(352) 360-6582 |
Full Name | Brad Broyles |
---|---|
Gender | Male |
Speciality | Psychiatry & Neurology - Psychiatry |
Location | 2018 Talley Rd, Leesburg, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1629033493 | NPI | - | NPPES |
263317500 | Medicaid | FL | |
03386 | Other | FL | BLUE CROSS BLUE SHIELD # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | ME 0071307 (Florida) | Primary |
Entity Name | Mental Health Resource Center Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1851407365 PECOS PAC ID: 2567446982 Enrollment ID: O20040615000219 |
Entity Name | Lifestream Behavioral Center Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1902802002 PECOS PAC ID: 7012992720 Enrollment ID: O20040618000512 |
Mailing Address | Practice Location Address |
---|---|
Brad Broyles, MD Po Box 491000, Leesburg, FL 34749-1000 Ph: (352) 315-7500 | Brad Broyles, MD 2018 Talley Rd, Leesburg, FL 34748-3426 Ph: (352) 315-7500 |
Kranthi Boyapati, MD Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 2020 Talley Rd, Leesburg, FL 34748 Phone: 352-315-7800 Fax: 352-360-6582 | |
Dr. Kenneth A. Henschel, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 10123 Us Highway 441, Leesburg, FL 34788 Phone: 352-426-5012 | |
Dr. Nidsa I Martir Cruz, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 26540 Ace Ave Ste H103, Leesburg, FL 34748 Phone: 352-323-0888 Fax: 352-323-9103 | |
Dr. Edgar Alfred Walker Jr., M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 215 N 3rd St, Leesburg, FL 34748 Phone: 352-315-7500 Fax: 352-360-6582 | |
Dr. Richard B Wallace, D.O. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 215 N 3rd St, Leesburg, FL 34748 Phone: 352-315-7900 Fax: 352-315-7587 | |
Dr. Revathi Iyengar, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 600 E Dixie Ave, Leesburg, FL 34748 Phone: 352-323-5467 Fax: 352-315-3633 | |
Thomas Valente, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 2020 Talley Rd, Leesburg, FL 34748 Phone: 352-315-7810 Fax: 352-360-6610 |