Healthcare Provider Details

I. General information

NPI: 1053415257
Provider Name (Legal Business Name): JEFFREY M BRAXTON M.D., F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 W ELLIOT RD STE 101
GILBERT AZ
85233-5162
US

IV. Provider business mailing address

PO BOX 208313
DALLAS TX
75320-8313
US

V. Phone/Fax

Practice location:
  • Phone: 480-374-7354
  • Fax: 480-371-1121
Mailing address:
  • Phone: 480-374-7354
  • Fax: 480-371-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number56713
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036084373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: