| Doctor Name: | MR. WILLES TODD BRAXTON |
| NPI Number: | 1710962642 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | B1673135 |
| Business Practice Address: | 5201 Lee Rd Kaehler Memorial Medical Clinic Buzzards Bay, MA - 025421313 |
| Business Phone Number: | 5089686578 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1766, MASHPEE |
| State: | MA |
| Postal Code: | 026491766 |
| Phone Number: | 5085644814 |
| Fax Number: | |
| NPI Enumeration Date: | 12/14/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | B1673135 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |