Provider Demographics
NPI:1043215239
Name:BRACER, RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:BRACER
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 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:701 PRINCETON AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1303
Practice Address - Country:US
Practice Address - Phone:205-868-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL200382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942009Medicaid
AL051519029OtherBLUE CROSS
AL009988265Medicaid
AL051526314OtherBLUE CROSS
AL515-94558OtherBLUE CROSS
AL105590Medicaid
AL009941714Medicaid
AL051539415OtherBLUE CROSS
AL051540900OtherBLUE CROSS
AL168711Medicaid
AL051519029Medicaid
AL511-09716OtherBLUE CROSS
AL511-56293OtherBLUE CROSS
AL122588Medicaid
AL168711Medicaid
AL105590Medicaid
AL009941714Medicaid
AL051519029OtherBLUE CROSS