MEDICARE: PASQUAL BRACERO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician	ME49965	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	OA173	OTHER	FL	MEDICARE HF

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205242	OTHER	FL	AVMED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2446154	OTHER	FL	AETNA HMO - GROUP
7	P1830864	OTHER	FL	OXFORD HEALTH
8	38471	OTHER	FL	BCBS - GROUP LOC. 1
9	4278951	OTHER	FL	AETNA PPO - INDIVIDUAL
10	4425436	OTHER	FL	AETNA PPO - GROUP
11	922260	OTHER	FL	AETNA - INDIVIDUAL
12	03928	OTHER	FL	BCBS - INDIVIDUAL
13	59-2873107 - D	OTHER	FL	HUMANA
14	0700168	OTHER	FL	UNITED HEALTHCARE
15	38471A	OTHER	FL	BCBS - GROUP LOC. 2

General Provider Information

NPI Number	:	1003827809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PASQUAL BRACERO M.D.

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD BLDG A
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	407-380-0302
Fax Number	:

Provider Business Practice Location Address
First Line	:	12315 LAKE UNDERHILL RD STE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4507
Country	:	US
Telephone Number	:	407-380-0302
Fax Number	:	407-380-5127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/31/2021

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