Basic Information
| Provider Information | |||||||||
| NPI: | 1598756918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRIGNONI | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 LOVELAND BLVD. | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417436866 | ||||||||
| FaxNumber: | 9417438598 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 LOVELAND BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417436866 | ||||||||
| FaxNumber: | 9417438598 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 04/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME59140 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 053068900 | 05 | FL | MEDICAID |