Provider Demographics
NPI:1427093368
Name:BRAVO-CAMPA, OSCAR R (MD)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:R
Last Name:BRAVO-CAMPA
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 1:7500 SW 8TH ST
Mailing Address - Street 2:PH #2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4400
Mailing Address - Country:US
Mailing Address - Phone:305-261-8001
Mailing Address - Fax:305-261-4485
Practice Address - Street 1:7500 SW 8TH ST
Practice Address - Street 2:PH #2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4400
Practice Address - Country:US
Practice Address - Phone:305-261-8001
Practice Address - Fax:305-261-4485
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 41182208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068194600Medicaid
FLE61773Medicare UPIN
FL96089Medicare ID - Type Unspecified