Provider Demographics
NPI:1790759645
Name:BRAVO, CESAR JOSE' (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:JOSE'
Last Name:BRAVO
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 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-238615207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790759645OtherANTHEM
VA1790759645OtherHEALTHKEEPERS
VA1790759645OtherVA PREMIER
VA1790759645OtherAETNA
VA1790759645OtherHEALTHKEEPERS PLUS
VA1790759645OtherHUMANA MEDICARE
VA1790759645OtherUNITED HEALTHCARE
VA371194700OtherOWCP
VA1790759645OtherVIRGINIA HEALTH NETWORK
VA371194700OtherBLACK LUNG
VA1790759645OtherOPTIMA HEALTH PLAN
VA3810006583OtherMEDICAID OF WEST VIRGINIA
VA1790759645OtherINTOTAL
VA1790759645OtherMEDICAID OF NORTH CAROLINE
VA1790759645OtherCOVENTRY/AETNA BETTER HEALTH
VA1790759645Medicaid
VA1790759645OtherUMWA
VA540506332004OtherTRICARE/CHAMPUS
VA1790759645OtherCIGNA
VA1790759645OtherGATEWAY
VAP00242289OtherRAILROAD MEDICARE
008326C19Medicare PIN
VA1790759645OtherCIGNA
VAI18377Medicare UPIN