MEDICARE: JOHN M BRACE DO & ASSOCIATES INC

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	207YX0602X	Otolaryngic Allergy Physician	34001908	OH

General Provider Information

NPI Number	:	1306154414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN M BRACE DO & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	2334 LAKE AVE
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-3440
Country	:	US
Telephone Number	:	440-992-0846
Fax Number	:	440-992-7879

Provider Business Practice Location Address
First Line	:	2334 LAKE AVE
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-3440
Country	:	US
Telephone Number	:	440-992-0846
Fax Number	:	440-992-7879

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	JOHN M. BRACE
Credential	:	D.O.
Telephone Number	:	440-992-0846

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/28/2010

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