Healthcare Provider Details

I. General information

NPI: 1558348383
Provider Name (Legal Business Name): TOMAS EDUARDO DE BRIGARD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NW 9TH AVE
MULBERRY FL
33860-2922
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 863-425-6200
  • Fax: 863-425-6219
Mailing address:
  • Phone: 863-268-7850
  • Fax: 863-268-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 54593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: