Healthcare Provider Details

I. General information

NPI: 1164510046
Provider Name (Legal Business Name): ELLIOT JAY BRAUN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 MONTLIMAR DR
MOBILE AL
36609-1645
US

IV. Provider business mailing address

1371 MONTLIMAR DR
MOBILE AL
36609-1645
US

V. Phone/Fax

Practice location:
  • Phone: 251-304-0804
  • Fax: 251-304-0806
Mailing address:
  • Phone: 251-304-0804
  • Fax: 251-304-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00064
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: