Provider Demographics
NPI:1235411000
Name:BRANDON-RIVERVIEW MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:BRANDON-RIVERVIEW MEDICAL ASSOCIATES PA
Other - Org Name:BRANDON-RIVERVIEW MEDICAL ASSOCIATES PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAGDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-655-4100
Mailing Address - Street 1:519 E BLOOMINGDALE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8180
Mailing Address - Country:US
Mailing Address - Phone:813-355-4100
Mailing Address - Fax:813-655-1775
Practice Address - Street 1:519 E BLOOMINGDALE AVE STE A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8180
Practice Address - Country:US
Practice Address - Phone:813-655-4100
Practice Address - Fax:813-655-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002M1OtherBCBS
FL002M1OtherBCBS