Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | OS 7345 | FL |
NPI | 1013970870 |
---|---|
Provider Name | Dr. David Michael Bracciano SR. |
First Address | Bradenton, FL 34211-8517 |
Second Address | University Park, FL 34201-2016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 14/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112939371 | (05) | MI |
F22176 | (02) | MI |