Provider Demographics
NPI:1588614952
Name:BRACAMONTE, PERCY RENATO (MD)
Entity Type:Individual
Prefix:DR
First Name:PERCY
Middle Name:RENATO
Last Name:BRACAMONTE
Suffix:
Gender:M
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:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:646 VIRGINIA ST
Practice Address - Street 2:SUITE 601
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6612
Practice Address - Country:US
Practice Address - Phone:727-734-9494
Practice Address - Fax:813-635-7869
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110131143OtherRAILROAD MEDICARE NUMBER
FL377308600Medicaid
FL26573WMedicare PIN
FL110131143OtherRAILROAD MEDICARE NUMBER