Individual
DR. BRUCE ROBERT BRAGONIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 PETALUMA AVE, SUITE B, SEBASTOPOL, CA 95472-4225
(707) 823-7602
(707) 823-7625
Mailing address
555 PETALUMA AVE, SUITE B, SEBASTOPOL, CA 95472-4225
(707) 823-7602
(707) 823-7625
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G75427
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G754270
PTAN
CA
05
—
00G754270
—
CA
Enumeration date
10/31/2005
Last updated
01/11/2011
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