Provider Demographics
NPI:1720143639
Name:JOHN D BRIGGS M D PA
Entity Type:Organization
Organization Name:JOHN D BRIGGS M D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-394-9292
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:SUITE340
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-394-9292
Mailing Address - Fax:
Practice Address - Street 1:660 GLADES RD STE 340
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6468
Practice Address - Country:US
Practice Address - Phone:561-394-9292
Practice Address - Fax:561-394-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61504Medicare ID - Type Unspecified
FLE11980Medicare UPIN