Provider Demographics
NPI:1598756918
Name:BRIGNONI, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BRIGNONI
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 1:2300 LOVELAND BLVD.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980
Mailing Address - Country:US
Mailing Address - Phone:941-743-6866
Mailing Address - Fax:941-743-8598
Practice Address - Street 1:2300 LOVELAND BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980
Practice Address - Country:US
Practice Address - Phone:941-743-6866
Practice Address - Fax:941-743-8598
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59140207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053068900Medicaid
FLE84506Medicare UPIN
FL12176YMedicare ID - Type Unspecified