Provider Demographics
NPI:1487643649
Name:ROY Z BRAUNSTEIN MD PA
Entity Type:Organization
Organization Name:ROY Z BRAUNSTEIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BRAUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-676-7624
Mailing Address - Street 1:749 STATE ROAD 60 E
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4240
Mailing Address - Country:US
Mailing Address - Phone:863-676-7624
Mailing Address - Fax:863-678-0263
Practice Address - Street 1:749 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4240
Practice Address - Country:US
Practice Address - Phone:863-676-7624
Practice Address - Fax:863-678-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042087207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN3581OtherRAILROAD MEDICARE
D21759Medicare UPIN
FLAK750Medicare PIN