Provider Demographics
NPI:1265751267
Name:BOGDANOWICZ, BRIAN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:BOGDANOWICZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 864074
Mailing Address - Street 2:HALIFAX HEALTHCARE SYSTEMS, INC.
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4074
Mailing Address - Country:US
Mailing Address - Phone:386-226-4590
Mailing Address - Fax:386-226-3371
Practice Address - Street 1:303 NO. CLYDE MORRIS BLVD.
Practice Address - Street 2:HALIFAX HEALTH MEDICAL CENTER & COMMUNITY CLINIC
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-425-6198
Practice Address - Fax:386-425-6197
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2012-03-08
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Provider Licenses
StateLicense IDTaxonomies
FLTRN15063207Q00000X
FLME110715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine