Provider Demographics
NPI:1275521445
Name:RANA, BRIJ BHUSHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIJ
Middle Name:BHUSHAN
Last Name:RANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRIJ
Other - Middle Name:BHUSHAN
Other - Last Name:RANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:609 5TH ST SW
Mailing Address - Street 2:STE 5
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-2239
Mailing Address - Country:US
Mailing Address - Phone:386-208-1200
Mailing Address - Fax:386-208-1300
Practice Address - Street 1:609 5TH ST SW
Practice Address - Street 2:STE 5
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2239
Practice Address - Country:US
Practice Address - Phone:386-208-1200
Practice Address - Fax:386-208-1300
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMD0000028083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3158071OtherBLUE CROSS
TN3807770Medicaid
TNG42052Medicare UPIN
TN3807770Medicaid