Healthcare Provider Details

I. General information

NPI: 1457544702
Provider Name (Legal Business Name): WILFREDO EDDY BRAVO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WILFREDO EDDY BRAVO LLERENA M.D.

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 W FLAGLER ST STE 215
CORAL GABLES FL
33134-1402
US

IV. Provider business mailing address

101415 OVERSEAS HWY
KEY LARGO FL
33037-4504
US

V. Phone/Fax

Practice location:
  • Phone: 954-368-4786
  • Fax: 954-368-4101
Mailing address:
  • Phone: 954-368-4786
  • Fax: 954-368-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME110036
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME110036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: