Provider Demographics
NPI:1447234463
Name:BOGGS, BRIAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:BOGGS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:701 W COCOA BEACH CSWY
Mailing Address - Street 2:CAPE CANAVERAL HOSPITAL EMERGENCY ROOM
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3585
Mailing Address - Country:US
Mailing Address - Phone:321-799-7150
Mailing Address - Fax:321-868-7249
Practice Address - Street 1:701 W COCOA BEACH CSWY
Practice Address - Street 2:CAPE CANAVERAL HOSPITAL EMERGENCY ROOM
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3585
Practice Address - Country:US
Practice Address - Phone:321-799-7150
Practice Address - Fax:321-868-7249
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME94032207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28695OtherBCBS
FL28695AMedicare ID - Type Unspecified