Organization
BRAVO HEALTH ADVANCED CARE CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIRK WALES MD (PRESIDENT)
(615) 236-6100
Entity
Organization
Contact information
Practice address
1601 CHESTNUT ST, PHILADELPHIA, PA 19192-4071
(267) 238-5825
(855) 803-5322
Mailing address
1500 SPRING GARDEN ST STE 800, PHILADELPHIA, PA 19130-4071
(267) 238-5825
(855) 803-5322
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
MD038974E
PA
Other
Enumeration date
04/01/2009
Last updated
12/03/2019
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