Provider Demographics
NPI:1326341116
Name:ROBERTO L. BRAGLIA, MD. PA
Entity Type:Organization
Organization Name:ROBERTO L. BRAGLIA, MD. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:L,
Authorized Official - Last Name:BRAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-888-4444
Mailing Address - Street 1:714 BOOTY ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2104
Mailing Address - Country:US
Mailing Address - Phone:361-888-4444
Mailing Address - Fax:361-882-6918
Practice Address - Street 1:714 BOOTY ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2104
Practice Address - Country:US
Practice Address - Phone:361-888-4444
Practice Address - Fax:361-882-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3687208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21454Medicare UPIN