Keith Bravo, Md | |
651 Colliers Way Suite 502 Weirton WV 26062-5053 | |
(304) 723-4328 | |
Not Available |
Full Name | Keith Bravo, Md |
---|---|
Speciality | Pediatrics |
Location | 651 Colliers Way, Weirton, West Virginia |
Authorized Official Name and Position | Keith Bravo (STAFF) |
Authorized Official Contact | 3047234328 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Keith Bravo, Md Po Box 2581 Weirton WV 26062-1781 Ph: (304) 723-6040 | Keith Bravo, Md 651 Colliers Way Suite 502 Weirton WV 26062-5053 Ph: (304) 723-4328 |
NPI Number | 1396949616 |
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Provider Enumeration Date | 06/12/2007 |
Last Update Date | 12/31/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396949616 | NPI | - | NPPES |
2147582 | Medicaid | OH | |
9298808 | Medicaid | OH | |
6000332000 | Medicaid | WV | |
0001352005 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 19983 (West Virginia) | Secondary |
208000000X | Pediatrics | 19983 (West Virginia) | Primary |
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