OrganizationActive
Bravo Iom LLC
NPI 1003372285 · Electrodiagnostic Medicine Physician · Ft Worth, TX
Provider details
- NPI number
- 1003372285
- Entity type
- Organization
- Primary specialty
- Electrodiagnostic Medicine PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Gina Sulllivan, Billing Manager
Practice location
111 Boland St Ste 211
Ft Worth, TX 76107-1265
Phone: (817) 529-8488
Fax: (903) 328-6568
Mailing address
111 Boland St Ste 211
Ft Worth, TX 76107-1265
Registry dates
- Enumerated
- 2019-02-13
- Last updated
- 2019-02-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.