Healthcare Provider Details

I. General information

NPI: 1972500999
Provider Name (Legal Business Name): GARY R. BRIGHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 FOY CT
CROWN POINT IN
46307-9821
US

IV. Provider business mailing address

1009 FOY CT
CROWN POINT IN
46307-9821
US

V. Phone/Fax

Practice location:
  • Phone: 219-662-2962
  • Fax:
Mailing address:
  • Phone: 219-662-2962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number01041362
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01041362A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: