Provider Demographics
NPI:1811955818
Name:BABBIN, BRIAN A (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:BABBIN
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:13691 METRO PKWY STE 120
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4348
Practice Address - Country:US
Practice Address - Phone:239-215-4066
Practice Address - Fax:239-237-2900
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054064207ZP0101X
FLME100043207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001863800Medicaid
FLP00820733OtherRAILROAD MEDICARE
FLP929867OtherFREEDOM OPTIMUM
FLP105177OtherFREEDOM HEALTH
FL2359360OtherCIGNA
FL2359360OtherCIGNA
FLP929867OtherFREEDOM OPTIMUM