Basic Information
Provider Information | |||||||||
NPI: | 1013984590 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BRIONES | ||||||||
FirstName: | FLORANTE | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6046 WHIPPLE AVE NW | ||||||||
Address2: |   | ||||||||
City: | NORTH CANTON | ||||||||
State: | OH | ||||||||
PostalCode: | 44720 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3304431200 | ||||||||
FaxNumber: | 3303055047 | ||||||||
Practice Location | |||||||||
Address1: | 2500 WALES AVENUE SW | ||||||||
Address2: |   | ||||||||
City: | MASSILLON | ||||||||
State: | OH | ||||||||
PostalCode: | 44646 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3304842584 | ||||||||
FaxNumber: | 3304843529 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/03/2006 | ||||||||
LastUpdateDate: | 05/22/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35035279 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 9912011 | 01 |   | MEDICARE GROUP PIN | OTHER | 0269203 | 05 | OH |   | MEDICAID | BR0380163 | 01 | OH | MEDICARE PTAN | OTHER |