Provider Demographics
NPI:1235186677
Name:BRANIGAN, EDWARD S III
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:BRANIGAN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 LITTLE HARBOUR LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2501
Mailing Address - Country:US
Mailing Address - Phone:772-234-5940
Mailing Address - Fax:
Practice Address - Street 1:70 ROYAL PALM PT
Practice Address - Street 2:SUITE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5200
Practice Address - Country:US
Practice Address - Phone:772-569-6600
Practice Address - Fax:772-569-5341
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71958OtherBLUE CROSS/BLUE SHIELD FL
FL71958OtherBLUE CROSS/BLUE SHIELD FL
FLD86259Medicare UPIN