Organization Name: | FRANCISCO EFRIAN BRAVO JR MD PC |
NPI Number: | 1104018217 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FRANCISCO EFRIAN BRAVO (OWNER) |
Mailing Address: | 302 E Downing St Tahlequah |
State: | OK US |
Postal Code: | 744643014 |
Phone Number: | 9184560655 |
Fax Number: | 9184561356 |
NPI Enumeration Date: | 08/13/2007 |
NPI Last Update Date: | 08/20/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | 19440 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |