=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437856853
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JONATHAN BRATTER, DO FACOG PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2023
-----------------------------------------------------
Last Update Date | 08/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 SHANEEHAW AVE SOUTH
-----------------------------------------------------
City | BANNER ELK
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-357-7314
-----------------------------------------------------
Fax | 828-372-4679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3489 NW 82ND TER
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-3165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-559-3765
-----------------------------------------------------
Fax | 954-447-2098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JONATHAN DAVID BRATTER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 954-261-4170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------