Provider Demographics
NPI:1700896701
Name:BRAVERMAN, STANLEY DEEMS (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:DEEMS
Last Name:BRAVERMAN
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1935 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:954-458-2114
Mailing Address - Fax:954-458-7186
Practice Address - Street 1:1935 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-458-2114
Practice Address - Fax:954-458-7186
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36565207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065368300Medicaid
FL065368300Medicaid