Individual
BRYAN BOGNAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-4530
Mailing address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME61825
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18923
BLUE CROSS BLUE SHIELD
FL
05
—
372844700
—
FL
Enumeration date
08/04/2006
Last updated
03/23/2015
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