Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G4853 | TX |
Y | 208600000X | Surgeon | G4853 | TX |
NPI | 1013044718 |
---|---|
Provider Name | Jose L Bravo |
First Address | Austin, TX 78701-1149 |
Second Address | Austin, TX 78701-1955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G4853 | LICENSE (01) | TX |