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General NPI Number Information
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NPI Number | 1407248792
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Entity Type | Organization
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Legal Business Name | DE BRIGARD PEDIATRICS, P.A
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 711 N PARSONS AVE
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City | BRANDON
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State | FL
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Zip | 33510-3406
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Country | US
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Telephone | 813-662-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 711 N PARSONS AVE
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City | BRANDON
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State | FL
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Zip | 33510-3406
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Country | US
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Telephone | 813-662-1200
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Fax |
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Authorized Official
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Title or Position | PRRSIDENT/PEDIATRICIAN
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Name | MISS TOMAS E. DE BRIGARD
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Credential | MD
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Telephone | 813-662-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME54593
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License Number State | FL
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