Healthcare Provider Details

I. General information

NPI: 1740228121
Provider Name (Legal Business Name): BRIAN PATRICK MAGRANE M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91550 OVERSEAS HWY SUITE 109
TAVERNIER FL
33070-2506
US

IV. Provider business mailing address

PO BOX 465
TAVERNIER FL
33070-0465
US

V. Phone/Fax

Practice location:
  • Phone: 305-853-5214
  • Fax: 305-853-5218
Mailing address:
  • Phone: 305-853-5214
  • Fax: 305-853-5218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0086408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: