Provider Demographics
NPI:1003827809
Name:BRACERO, PASQUAL (MD)
Entity Type:Individual
Prefix:
First Name:PASQUAL
Middle Name:
Last Name:BRACERO
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 1:3300 S FISKE BLVD BLDG A
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:407-380-0302
Mailing Address - Fax:
Practice Address - Street 1:12315 LAKE UNDERHILL RD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4507
Practice Address - Country:US
Practice Address - Phone:407-380-0302
Practice Address - Fax:407-380-5127
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49965207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL205242OtherAVMED
FL261-853-201Medicaid
FL045-914-300Medicaid
FL261-853-200Medicaid
FLOA173OtherMEDICARE HF
FL2446154OtherAETNA HMO - GROUP
FLP1830864OtherOXFORD HEALTH
FL38471OtherBCBS - GROUP LOC. 1
FL4278951OtherAETNA PPO - INDIVIDUAL
FL4425436OtherAETNA PPO - GROUP
FL922260OtherAETNA - INDIVIDUAL
FL03928OtherBCBS - INDIVIDUAL
FL59-2873107 - DOtherHUMANA
FL0700168OtherUNITED HEALTHCARE
FL38471AOtherBCBS - GROUP LOC. 2