Healthcare Provider Details

I. General information

NPI: 1144475856
Provider Name (Legal Business Name): JOHN PAUL BRAUT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E OLYMPIA AVE SUITE 211
PUNTA GORDA FL
33950-3823
US

IV. Provider business mailing address

315 E OLYMPIA AVE SUITE 211
PUNTA GORDA FL
33950-3823
US

V. Phone/Fax

Practice location:
  • Phone: 941-637-2663
  • Fax: 941-637-6872
Mailing address:
  • Phone: 941-637-2663
  • Fax: 941-637-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS12175
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: