Provider Demographics
NPI:1063414951
Name:BRAGLIA, ROBERTO LUDOVICO (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:LUDOVICO
Last Name:BRAGLIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BOOTY ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2104
Mailing Address - Country:US
Mailing Address - Phone:361-888-4444
Mailing Address - Fax:361-882-6918
Practice Address - Street 1:714 BOOTY ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2104
Practice Address - Country:US
Practice Address - Phone:361-888-4444
Practice Address - Fax:361-882-6918
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3687208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033039101Medicaid
B21454Medicare UPIN
TX033039101Medicaid