Healthcare Provider Details

I. General information

NPI: 1760470058
Provider Name (Legal Business Name): JOHN M BRAVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST RADIOLOGY, BRIGHAM & WOMEN'S HOSPITAL
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST RADIOLOGY, BRIGHAM & WOMEN'S HOSPITAL
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6295
  • Fax: 617-535-7333
Mailing address:
  • Phone: 617-732-6295
  • Fax: 617-264-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number37202
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number37202
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: