Provider Demographics
NPI:1831183003
Name:BRIEN, GINGE (MD)
Entity type:Individual
Prefix:DR
First Name:GINGE
Middle Name:
Last Name:BRIEN
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 1:1217 SW 120TH WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3871
Mailing Address - Country:US
Mailing Address - Phone:954-536-4903
Mailing Address - Fax:833-937-1859
Practice Address - Street 1:1217 SW 120TH WAY
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-3871
Practice Address - Country:US
Practice Address - Phone:954-536-4903
Practice Address - Fax:833-937-1859
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075666207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265939500Medicaid
FL265939500Medicaid
FLE-1584Medicare ID - Type Unspecified