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NPI Code Detail

MEDICARE: DR. THOMAS MARK BRAXTON JR. MD

MEDICARE:  DR. THOMAS MARK BRAXTON JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician00024642AL
2207QS0010XSports Medicine (Family Medicine) Physician43829KY
3207Q00000XFamily Medicine Physician43065TN
4207P00000XEmergency Medicine Physician43829KY
5207P00000XEmergency Medicine Physician43065TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578539672
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS MARK BRAXTON JR. MD
Provider Business Mailing Address
First Line : 595 STATE ROUTE 408 E
Second Line :
City : HICKORY
State : KY
Zip : 42051-9537
Country : US
Telephone Number : 270-804-9727
Fax Number :
Provider Business Practice Location Address
First Line : 1111 MEDICAL CENTER CIR
Second Line :
City : MAYFIELD
State : KY
Zip : 42066-1194
Country : US
Telephone Number : 270-251-4085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 03/07/2015

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