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 1:101415 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-4504
Mailing Address - Country:US
Mailing Address - Phone:954-368-4786
Mailing Address - Fax:954-368-4101
Practice Address - Street 1:4800 W FLAGLER ST STE 215
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1402
Practice Address - Country:US
Practice Address - Phone:954-368-4786
Practice Address - Fax:954-368-4101
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110036207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine