Basic Information
| Provider Information | |||||||||
| NPI: | 1124025531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRINGAS | ||||||||
| FirstName: | ENRIQUE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 865 LINCOLN RD | ||||||||
| Address2: | SUITE L10 | ||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527224190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633559191 | ||||||||
| FaxNumber: | 5633553419 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 VALLEY VIEW DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097649404 | ||||||||
| FaxNumber: | 3097649406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/18/2006 | ||||||||
| NPIReactivationDate: | 03/23/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036099834 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 91287 | 01 | IA | WELLMARK BC/BS | OTHER | 036099834 | 05 | IL | MEDICAID | 067317 | 01 | HEALTH ALLIANCE | OTHER | H09474 | 05 | IL | MEDICAID | IL01E5 | 01 | JOHN DEERE HEALTH PLANS | OTHER | 4796890021 | 01 | DMERC | OTHER | 510146 | 01 | IOWA HEALTH SOLUTIONS | OTHER |