Individual
DR. JASON BRAVO ALISANGCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4500 8TH DIVISION RD, COLUMBIA, SC 29207-5700
(803) 730-7081
Mailing address
4500 8TH DIVISION RD, COLUMBIA, SC 29207-5700
(803) 730-7081
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
63624
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
63624
GA
Other
Enumeration date
07/18/2008
Last updated
02/24/2025
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