Healthcare Provider Details

I. General information

NPI: 1144859166
Provider Name (Legal Business Name): JOHANN PAUL BRAITHWAITE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2513
US

IV. Provider business mailing address

3402 RUSHING WATERS DR
MELBOURNE FL
32904-8146
US

V. Phone/Fax

Practice location:
  • Phone: 305-495-3761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number110629
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: