Healthcare Provider Details

I. General information

NPI: 1871908889
Provider Name (Legal Business Name): PETER BRACHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 MEDICO LN STE 103
MELBOURNE FL
32940-8449
US

IV. Provider business mailing address

2329 MEDICO LN STE 103
MELBOURNE FL
32940-8449
US

V. Phone/Fax

Practice location:
  • Phone: 321-735-8800
  • Fax: 321-690-2288
Mailing address:
  • Phone: 321-735-8800
  • Fax: 321-690-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD463923
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number47187
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number72615
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11018097A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME17847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: