Basic Information
| Provider Information | |||||||||
| NPI: | 1023671856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAHAM | ||||||||
| FirstName: | JULAINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2805 54TH AVE N STE 500 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337142414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273415800 | ||||||||
| FaxNumber: | 7273415307 | ||||||||
| Practice Location | |||||||||
| Address1: | 2805 54TH AVE N STE 500 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337142414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273415800 | ||||||||
| FaxNumber: | 7273415307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2019 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME154793 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.