Provider Demographics
NPI:1235294182
Name:BRACAMONTE, ERIKA R (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:R
Last Name:BRACAMONTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-4135
Mailing Address - Fax:520-874-7048
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-874-4135
Practice Address - Fax:520-874-7048
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36183207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172281Medicaid
AZZWCGCROtherGROUP MEDICARE NUMBER
AZ36183OtherMD LICENSE
AZP00387430OtherRR MEDICARE
AZZWCGCROtherGROUP MEDICARE NUMBER
AZ172281Medicaid