Individual
JULIO RAFAEL BRAVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
312 JONESTOWN RD, WINSTON SALEM, NC 27104-4621
(336) 716-7576
(336) 702-9342
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 713-0947
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
22552
LA
207RR0500X
Rheumatology Physician
Primary
36657
NC
207RR0500X
Rheumatology Physician
92445
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598739823
—
VA
05
—
1987158
—
LA
01
—
202G701531
MEDICARE ID
GA
05
—
5907255
—
NC
01
—
P00479037
RAILROAD MEDICARE
NC
Enumeration date
02/14/2006
Last updated
02/29/2024
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