Individual
JUAN OSCAR BRAVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, CWS
Contact information
Practice address
170 FITZGERALD RD STE 1, LAKELAND, FL 33813-2633
(863) 777-2736
(863) 777-2724
Mailing address
170 FITZGERALD RD STE 1, LAKELAND, FL 33813-2633
(863) 777-2736
(863) 777-2724
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
ME74194
FL
207Q00000X
Family Medicine Physician
ME-74194
FL
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
ME74194
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271611900
—
FL
01
—
44573
BCBS
FL
Enumeration date
08/30/2006
Last updated
03/29/2023
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