Provider Demographics
NPI:1578560959
Name:BRIGNAC, RAYMOND NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:NEIL
Last Name:BRIGNAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:901 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6746
Mailing Address - Country:US
Mailing Address - Phone:334-875-2640
Mailing Address - Fax:334-875-2645
Practice Address - Street 1:901 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6746
Practice Address - Country:US
Practice Address - Phone:334-875-2640
Practice Address - Fax:334-875-2645
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00008538207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000005621Medicare ID - Type UnspecifiedPROVIDER#
ALC78732Medicare UPIN