Provider Demographics
NPI:1114939949
Name:BRAU, RICARDO H (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:H
Last Name:BRAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:400 FD ROOSEVELT AVENUE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2132
Mailing Address - Country:US
Mailing Address - Phone:787-763-1310
Mailing Address - Fax:787-766-7607
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 511
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-763-1310
Practice Address - Fax:787-766-7607
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5917207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5917OtherSTATE LICENSE
AL7504OtherSTATE LICENCE
D08418Medicare UPIN
PR0027418Medicare ID - Type Unspecified