Provider Demographics
NPI:1013958859
Name:EDWARD S. BRANIGAN III M.D. P.A.
Entity Type:Organization
Organization Name:EDWARD S. BRANIGAN III M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-569-6600
Mailing Address - Street 1:70 ROYAL PALM PT
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5200
Mailing Address - Country:US
Mailing Address - Phone:772-569-6600
Mailing Address - Fax:772-569-5341
Practice Address - Street 1:70 ROYAL PALM PT
Practice Address - Street 2:SUITE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5200
Practice Address - Country:US
Practice Address - Phone:772-569-6600
Practice Address - Fax:772-569-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0090Medicare ID - Type UnspecifiedPRACTICE MEDICARE #