Organization
JORGE J BRAVO MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE J BRAVO II MD (PRESIDENT)
(985) 446-8994
Entity
Organization
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301-4847
(985) 446-8994
(985) 447-8385
Mailing address
PO BOX 1449, THIBODAUX, LA 70302-1449
(985) 446-8994
(985) 447-8385
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1798215
—
LA
Enumeration date
08/04/2006
Last updated
08/22/2020
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