Individual
DR. RICHARD LEE BRAITHWAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1340 RIDGEWOOD AVE, HOLLY HILL, FL 32117-2320
(386) 676-7130
(386) 676-7125
Mailing address
P.O. BOX 9671, DAYTONA BEACH, FL 32120-9671
(386) 676-7130
(386) 676-7125
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
ME90496
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636
BCBS
FL
01
—
1730107509
TRICARE
FL
05
—
275120800
—
FL
01
—
P01348388
RAILROAD
FL
Enumeration date
07/18/2006
Last updated
02/22/2016
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