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NPI Code Detail

MEDICARE: DR. TOMAS EDUARDO DE BRIGARD M.D

MEDICARE: DR. TOMAS EDUARDO DE BRIGARD M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianME 54593FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558348383
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TOMAS EDUARDO DE BRIGARD M.D
Provider Business Mailing Address
First Line : 47 5TH ST NW
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33881-4672
Country : US
Telephone Number : 863-268-7850
Fax Number : 863-268-7899
Provider Business Practice Location Address
First Line : 106 NW 9TH AVE
Second Line :
City : MULBERRY
State : FL
Zip : 33860-2922
Country : US
Telephone Number : 863-425-6200
Fax Number : 863-425-6219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 12/14/2017

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