Healthcare Provider Details

I. General information

NPI: 1598756918
Provider Name (Legal Business Name): ANTHONY BRIGNONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 LOVELAND BLVD SUITE 1
PORT CHARLOTTE FL
33980
US

IV. Provider business mailing address

2300 LOVELAND BLVD. SUITE 1
PORT CHARLOTTE FL
33980
US

V. Phone/Fax

Practice location:
  • Phone: 941-743-6866
  • Fax: 941-743-8598
Mailing address:
  • Phone: 941-743-6866
  • Fax: 941-743-8598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME59140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: