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General NPI Number Information
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NPI Number | 1306154414
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Entity Type | Organization
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Legal Business Name | JOHN M BRACE DO & ASSOCIATES INC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 2334 LAKE AVE
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City | ASHTABULA
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State | OH
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Zip | 44004-3440
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Country | US
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Telephone | 440-992-0846
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Fax | 440-992-7879
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Provider Business Mailing Address
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Address Line | 2334 LAKE AVE
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City | ASHTABULA
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State | OH
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Zip | 44004-3440
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Country | US
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Telephone | 440-992-0846
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Fax | 440-992-7879
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | JOHN M. BRACE
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Credential | D.O.
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Telephone | 440-992-0846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number | 34001908
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License Number State | OH
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