Doctor Name: | DR. THOMAS MARK BRAXTON |
NPI Number: | 1578539672 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 00024642 |
Business Practice Address: | 1111 Medical Center Cir Mayfield, KY - 420661194 |
Business Phone Number: | 2702514085 |
Business Fax Number: | |
Mailing Address: | 595 State Route 408 E, HICKORY |
State: | KY |
Postal Code: | 420519537 |
Phone Number: | 2708049727 |
Fax Number: | |
NPI Enumeration Date: | 02/27/2006 |
NPI Last Update Date: | 03/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 00024642 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |