Provider Demographics
NPI:1912999665
Name:BRASINGTON, ALLEN T (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:T
Last Name:BRASINGTON
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 1:6021 NW 1ST PLACE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607
Mailing Address - Country:US
Mailing Address - Phone:352-331-1902
Mailing Address - Fax:352-331-1906
Practice Address - Street 1:6021 NW 1ST PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-331-1902
Practice Address - Fax:352-331-1906
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2009-07-10
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2007-09-05
Provider Licenses
StateLicense IDTaxonomies
FL0058527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110058871OtherRAILROAD MEDICARE
FL058525400Medicaid
FL14461OtherBLUE CROSS BLUE SHIELD
FLP00713824OtherRR MEDICARE
F10350Medicare UPIN
FL110058871OtherRAILROAD MEDICARE
FL058525400Medicaid