Provider Demographics
NPI:1407810971
Name:BRAVER, YVONNE J (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:J
Last Name:BRAVER
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:2237 LITHIA CENTER LN
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5676
Practice Address - Country:US
Practice Address - Phone:813-662-0123
Practice Address - Fax:813-662-9422
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078470B207R00000X
FLME116804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMY196OtherMEDICARE
OH2182392Medicaid
OHBR7345481Medicare PIN