Provider Demographics
NPI:1245408897
Name:CRAIG A. TRIGUEIRO, MD, PA
Entity Type:Organization
Organization Name:CRAIG A. TRIGUEIRO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIGUEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-753-7843
Mailing Address - Street 1:4805 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1706
Mailing Address - Country:US
Mailing Address - Phone:941-753-7843
Mailing Address - Fax:941-753-7845
Practice Address - Street 1:4805 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1706
Practice Address - Country:US
Practice Address - Phone:941-753-7843
Practice Address - Fax:941-753-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00039928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1007Medicare PIN
FLD84415Medicare UPIN