Provider Demographics
NPI:1548201288
Name:BRAVO, FRANCISCO EFRAIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:EFRAIN
Last Name:BRAVO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1008
Mailing Address - Country:US
Mailing Address - Phone:918-207-1189
Mailing Address - Fax:918-207-1160
Practice Address - Street 1:1500 E. DOWNING
Practice Address - Street 2:#102
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-207-1189
Practice Address - Fax:918-207-1160
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK19440174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100168350AMedicaid
OK100168350AMedicaid
OKOK403698Medicare PIN