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General NPI Number Information
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NPI Number | 1437339280
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Entity Type | Organization
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Legal Business Name | MIGUEL A BRAVO MD SURGICAL ASSOCIATES INC
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 420 S JAMES ST SUITE B
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City | DOVER
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State | OH
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Zip | 44622-3206
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Country | US
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Telephone | 330-602-7707
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Fax | 330-602-6071
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Provider Business Mailing Address
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Address Line | 420 S JAMES ST SUITE B
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City | DOVER
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State | OH
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Zip | 44622-3206
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Country | US
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Telephone | 330-602-7707
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Fax | 330-602-6071
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Authorized Official
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Title or Position | MEDICAL DOCTOR OWNER
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Name | DR. MIGUEL A BRAVO
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Credential | MD
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Telephone | 330-602-7707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 52476
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License Number State | OH
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