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General NPI Number Information
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NPI Number | 1710184098
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Entity Type | Individual
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Provider Name | BRIAN J DEIGNAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 3003 W DR MARTIN LUTHER KING JR BLVD MAB-3RD FLOOR
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City | TAMPA
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State | FL
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Zip | 33607-6307
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Country | US
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Telephone | 813-554-8983
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Fax | 813-443-8177
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Provider Business Mailing Address
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Address Line | PO BOX 743409
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City | ATLANTA
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State | GA
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Zip | 30374-3409
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Country | US
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Telephone | 727-532-0002
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Fax | 727-532-1325
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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 | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | ME115264
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License Number State | FL
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