Provider Demographics
NPI:1164596557
Name:LAVERGNE, BRIGITTA S (MD)
Entity Type:Individual
Prefix:
First Name:BRIGITTA
Middle Name:S
Last Name:LAVERGNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIGITTA
Other - Middle Name:
Other - Last Name:SENTIRMAY SZENTIRMAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-7000
Mailing Address - Fax:208-302-7055
Practice Address - Street 1:1150 N SISTER CATHERINE WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687
Practice Address - Country:US
Practice Address - Phone:208-302-7000
Practice Address - Fax:208-302-7055
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056490207Q00000X
IDM-10373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08BCBCXMedicare ID - Type Unspecified
I42118Medicare UPIN
I42118Medicare UPIN