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General NPI Number Information
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NPI Number | 1922289875
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Entity Type | Organization
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Legal Business Name | MARK S. BRIGHAM, DO, INC.
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 195 WADSWORTH RD SUITE 401
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City | WADSWORTH
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State | OH
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Zip | 44281-9504
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Country | US
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Telephone | 330-336-8717
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Fax | 330-335-0092
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Provider Business Mailing Address
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Address Line | 195 WADSWORTH RD SUITE 401
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City | WADSWORTH
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State | OH
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Zip | 44281-9504
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Country | US
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Telephone | 330-336-8717
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Fax | 330-335-0092
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Authorized Official
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Title or Position | MANAGER
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Name | DARCILLA OLSHAVSKY
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Credential |
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Telephone | 330-336-8717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 34005567
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License Number State | OH
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