MEDICARE: RICHARD SCOTT BRAGG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME0065139	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558336347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD SCOTT BRAGG MD

Provider Business Mailing Address
First Line	:	580 RINEHART RD
Second Line	:	SUITE 110
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1551
Country	:	US
Telephone Number	:	407-805-8989
Fax Number	:	407-805-8833

Provider Business Practice Location Address
First Line	:	580 RINEHART RD
Second Line	:	SUITE 110
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1551
Country	:	US
Telephone Number	:	407-805-8989
Fax Number	:	407-805-8833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	01/22/2013

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