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General NPI Number Information
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NPI Number | 1124025531
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Entity Type | Individual
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Provider Name | ENRIQUE M. BRINGAS MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 615 VALLEY VIEW DR SUITE 201
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City | MOLINE
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State | IL
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Zip | 61265-6150
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Country | US
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Telephone | 309-764-9404
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Fax | 309-764-9406
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Provider Business Mailing Address
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Address Line | 865 LINCOLN RD SUITE L10
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City | BETTENDORF
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State | IA
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Zip | 52722-4190
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Country | US
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Telephone | 563-355-9191
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Fax | 563-355-3419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036099834
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License Number State | IL
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