Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 5917 | PR |
NPI | 1114939949 |
---|---|
Provider Name | Dr. Ricardo H Brau |
First Address | San Juan, PR 00918-2132 |
Second Address | San Juan, PR 00918-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5917 | STATE LICENSE (01) | PR |
7504 | STATE LICENCE (01) | AL |
D08418 | (02) |