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General NPI Number Information
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NPI Number | 1154402444
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Entity Type | Individual
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Provider Name | ERIC BRAVO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 505 W PERSHING BLVD STE C
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72114-2157
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Country | US
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Telephone | 501-758-7352
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Fax | 501-771-5014
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Provider Business Mailing Address
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Address Line | 505 W PERSHING BLVD STE C
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72114-2157
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Country | US
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Telephone | 501-758-7352
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Fax | 501-771-5014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E2466
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License Number State | AR
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