Provider Demographics
NPI:1366552234
Name:KAGAN, BRIAN MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MARTIN
Last Name:KAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4957 38TH AVE N
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2174
Mailing Address - Country:US
Mailing Address - Phone:727-526-7420
Mailing Address - Fax:727-525-0675
Practice Address - Street 1:4957 38TH AVE N
Practice Address - Street 2:SUITE A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2174
Practice Address - Country:US
Practice Address - Phone:727-526-7420
Practice Address - Fax:727-525-0675
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58980Medicare UPIN