Healthcare Provider Details

I. General information

NPI: 1902127186
Provider Name (Legal Business Name): RYAN J BROGAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 NEMOURS PKWY
ORLANDO FL
32827-7884
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-4000
  • Fax: 302-651-4945
Mailing address:
  • Phone: 904-697-4100
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS12184
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS12184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: