NPIMap

Organization Active NPI

Jorge J Bravo MD a Professional Corporation

  • Anesthesiology Physician
  • Thibodaux, LA
National Provider Identifier
1801804646
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
JORGE J BRAVO MD A PROFESSIONAL CORPORATION
Practice address
602 N Acadia Rd
Thibodaux, LA 70301-4847
Phone
(985) 446-8994
Fax
(985) 447-8385
NPI assigned
Aug 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jorge J Bravo II, MDNPI 1598726853
Title
President
Phone
(985) 446-8994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

602 N Acadia Rd
Thibodaux, LA 70301-4847

Mailing address

PO Box 1449
Thibodaux, LA 70302-1449
Phone (985) 446-8994

Other identifiers 1

IdentifierTypeStateIssuer
1798215MedicaidLA

National Provider Directory

National Provider Directory

Locations

2000 Audubon Ave
Ste A
Thibodaux, LA 70301
Phone (337) 828-2678

602 N Acadia Rd
#M
Thibodaux, LA 70301
Phone (985) 493-4740

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 42

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801804646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703021449",
            "telephone_number": "985-446-8994",
            "fax_number": "985-447-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N ACADIA RD",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014847",
            "telephone_number": "985-446-8994",
            "fax_number": "985-447-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORGE J BRAVO MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRAVO",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "985-446-8994",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1798215",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thibodaux, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.