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NPI Code Detail

MEDICARE: MARK STEVEN BRIGHAM DO

MEDICARE: MARK STEVEN BRIGHAM DO
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
1207Y00000XOtolaryngology Physician34005567OH

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 : 1740261387
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK STEVEN BRIGHAM DO
Provider Business Mailing Address
First Line : 195 WADSWORTH RD
Second Line : SUITE 401
City : WADSWORTH
State : OH
Zip : 44281-9504
Country : US
Telephone Number : 330-336-8717
Fax Number : 330-335-0092
Provider Business Practice Location Address
First Line : 195 WADSWORTH RD
Second Line : SUITE 401
City : WADSWORTH
State : OH
Zip : 44281-9504
Country : US
Telephone Number : 330-336-8717
Fax Number : 330-335-0092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 10/14/2010

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