Provider Demographics
NPI:1457544702
Name:BRAVO, WILFREDO EDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:EDDY
Last Name:BRAVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILFREDO
Other - Middle Name:EDDY
Other - Last Name:BRAVO LLERENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3421 SW 124TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2953
Mailing Address - Country:US
Mailing Address - Phone:787-286-1845
Mailing Address - Fax:787-747-6051
Practice Address - Street 1:3421 SW 124TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2953
Practice Address - Country:US
Practice Address - Phone:787-286-1845
Practice Address - Fax:787-747-6051
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110036207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism