1861434417 NPI number — ROBERT BRAUNER MD PL

Table of content: (NPI 1861434417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861434417 NPI number — ROBERT BRAUNER MD PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT BRAUNER MD PL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHSIDE OB/GYN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861434417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13601 BRUCE B DOWNS BLVD
Provider Second Line Business Mailing Address:
SUITE 121
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-979-9100
Provider Business Mailing Address Fax Number:
813-979-1175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13601 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-979-9100
Provider Business Practice Location Address Fax Number:
813-979-1175
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRAUNER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-979-9100

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: ME39272 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 067627600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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