| Doctor Name: | DR. BRIAN RANDALL RILEY |
| NPI Number: | 1053367391 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 02002196A |
| Business Practice Address: | 1562 Mitscher Ave Ste 250 U.s. Fleet Forces Command/no2hc Norfolk, VA - 235512423 |
| Business Phone Number: | 7578365538 |
| Business Fax Number: | |
| Mailing Address: | 11 Kestral Way, KEY WEST |
| State: | FL |
| Postal Code: | 330407922 |
| Phone Number: | 3059231144 |
| Fax Number: | |
| NPI Enumeration Date: | 05/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 02002196A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |