Provider Demographics
NPI:1215432919
Name:BRAVO, RICHARD DEGUZMAN JR (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEGUZMAN
Last Name:BRAVO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5700
Mailing Address - Country:US
Mailing Address - Phone:813-684-2229
Mailing Address - Fax:813-916-2944
Practice Address - Street 1:505 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5700
Practice Address - Country:US
Practice Address - Phone:813-684-2229
Practice Address - Fax:813-916-2944
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18373207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program