Provider Demographics
NPI:1942206057
Name:BRICIO, EUGENIO M (MD)
Entity Type:Individual
Prefix:
First Name:EUGENIO
Middle Name:M
Last Name:BRICIO
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 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:20803 BISCAYNE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:954-265-7900
Practice Address - Fax:954-276-0254
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61500207RC0000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL295149OtherAVMED
FL26270OtherBLUE CROSS BLUE SHIELD
FL9745538OtherGHI
FL5467191OtherAETNA
FL3059031564Medicaid
FL26270YMedicare PIN
FL9745538OtherGHI
FL5467191OtherAETNA