Organization
WOUND & SKIN EXPERTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN O BRAVO M.D (PROVIDER/OWNER)
(863) 398-8362
Entity
Organization
Contact information
Practice address
1514 S ALEXANDER ST, SUITE 204, PLANT CITY, FL 33563-8415
(813) 754-7756
(813) 754-7565
Mailing address
1514 S ALEXANDER ST, SUITE 204, PLANT CITY, FL 33563-8415
(813) 754-7756
(813) 754-7565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014765700
—
FL
Enumeration date
01/14/2015
Last updated
08/01/2016
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