1740228121 NPI number — DR. BRIAN PATRICK MAGRANE M.D.,

Table of content: DR. BRIAN PATRICK MAGRANE M.D., (NPI 1740228121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740228121 NPI number — DR. BRIAN PATRICK MAGRANE M.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGRANE
Provider First Name:
BRIAN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740228121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAVERNIER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33070-0465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-853-5214
Provider Business Mailing Address Fax Number:
305-853-5218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91550 OVERSEAS HWY
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
TAVERNIER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33070-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-853-5214
Provider Business Practice Location Address Fax Number:
305-853-5218
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME0086408 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 57716 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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