Provider Demographics
NPI:1245456714
Name:ANTONIO C. BRAGA M.D., P.A.
Entity type:Organization
Organization Name:ANTONIO C. BRAGA M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-573-4313
Mailing Address - Street 1:4304 N. LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-573-4313
Mailing Address - Fax:361-573-4327
Practice Address - Street 1:4304 N. LAURENT ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-573-4313
Practice Address - Fax:361-573-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127140503Medicaid
TX356729904Medicaid
TX127140501Medicaid
TX130937902Medicaid