Provider Demographics
NPI:1407014814
Name:BARGNESI, DAVID SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:BARGNESI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5263
Mailing Address - Country:US
Mailing Address - Phone:904-264-8418
Mailing Address - Fax:904-264-9692
Practice Address - Street 1:1715 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5263
Practice Address - Country:US
Practice Address - Phone:904-264-8418
Practice Address - Fax:904-264-9692
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105906208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE193118ZA5HOtherMEDICARE GROUP MEMBER PTAN
FLGS730AOtherMEDICARE GROUP PTAN FPS
FLK7038BOtherMEDICARE GROUP PTAN ICON