ANTHONY J BRAVO MD
Physician/surgeon


Address: 160 Red Oak Rd, Fairfield, CT 06430

ANTHONY J BRAVO MD (Credential# 540297) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is September 8, 2004. The license expiration date date is October 31, 2005. The license status is INACTIVE.

Business Overview

ANTHONY J BRAVO MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.012314. The credential type is physician/surgeon. The effective date is September 8, 2004. The expiration date is October 31, 2005. The business address is 160 Red Oak Rd, Fairfield, CT 06430. The current status is inactive.

Basic Information

Licensee Name ANTHONY J BRAVO MD
Credential ID 540297
Credential Number 1.012314
Credential Type Physician/Surgeon
Business Address 160 Red Oak Rd
Fairfield
CT 06430
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1901-01-01
Effective Date 2004-09-08
Expiration Date 2005-10-31
Refresh Date 2009-07-11

Other licenses

ID Credential Code Credential Type Issue Term Status
160738 CSP.0017587 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2004-02-29 - 2005-02-28 INACTIVE

Office Location

Street Address 160 RED OAK RD
City FAIRFIELD
State CT
Zip Code 06430

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Competitor

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City FAIRFIELD
Zip Code 06430
License Type Physician/Surgeon
License Type + County Physician/Surgeon + FAIRFIELD

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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