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General NPI Number Information
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NPI Number | 1922028612
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Entity Type | Individual
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Provider Name | LARRY BRAVER D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 8245 HOLLY RD STE 102A
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City | GRAND BLANC
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State | MI
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Zip | 48439-2443
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Country | US
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Telephone | 810-694-0300
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Fax | 810-694-0710
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Provider Business Mailing Address
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Address Line | 8245 HOLLY RD STE 102A
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City | GRAND BLANC
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State | MI
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Zip | 48439-2443
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Country | US
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Telephone | 810-694-0300
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Fax | 810-694-0710
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LB007238
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License Number State | MI
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