Provider Demographics
NPI:1912649666
Name:BRANDON BIDEGARAY, IAN CHRISTIAN (DO)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:CHRISTIAN
Last Name:BRANDON BIDEGARAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4263 LOSCO RD APT 111
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1456
Mailing Address - Country:US
Mailing Address - Phone:786-251-7111
Mailing Address - Fax:
Practice Address - Street 1:15955 SW 96TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1272
Practice Address - Country:US
Practice Address - Phone:786-467-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program