Provider Demographics
NPI:1770671216
Name:BRIAN J INGLERIGHT D.O., INC
Entity type:Organization
Organization Name:BRIAN J INGLERIGHT D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:INGLERIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-592-1243
Mailing Address - Street 1:14540 CORTEZ BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6056
Mailing Address - Country:US
Mailing Address - Phone:352-592-1243
Mailing Address - Fax:352-592-1246
Practice Address - Street 1:14540 CORTEZ BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6056
Practice Address - Country:US
Practice Address - Phone:352-592-1243
Practice Address - Fax:352-592-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274813400Medicaid
FL274813400Medicaid
FL35742ZMedicare ID - Type Unspecified