Healthcare Provider Details

I. General information

NPI: 1639681471
Provider Name (Legal Business Name): BRIGANTTI ANESTHESIA & SPINE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE SOUTH SUITE #210
JACKSONVILLE FL
32224
US

IV. Provider business mailing address

1361 13TH AVE S STE 210
JACKSONVILLE FL
32250-3236
US

V. Phone/Fax

Practice location:
  • Phone: 407-994-5909
  • Fax:
Mailing address:
  • Phone: 407-994-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. RUBEN XAVIER PAGAN
Title or Position: CEO
Credential: MD
Phone: 407-994-5909