Basic Information
| Provider Information | |||||||||
| NPI: | 1265751267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOGDANOWICZ | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 864074 | ||||||||
| Address2: | HALIFAX HEALTHCARE SYSTEMS, INC. | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328864074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862264590 | ||||||||
| FaxNumber: | 3862263371 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 NO. CLYDE MORRIS BLVD. | ||||||||
| Address2: | HALIFAX HEALTH MEDICAL CENTER & COMMUNITY CLINIC | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864256198 | ||||||||
| FaxNumber: | 3864256197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2010 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TRN15063 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME110715 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.