Healthcare Provider Details

I. General information

NPI: 1538117056
Provider Name (Legal Business Name): PAUL J BRAATON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 COFFEE ROAD SUITE 100
MODESTO CA
95355-3192
US

IV. Provider business mailing address

1335 COFFEE ROAD SUITE 100
MODESTO CA
95355-3192
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-4438
  • Fax: 209-524-7395
Mailing address:
  • Phone: 209-524-4438
  • Fax: 209-524-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number00G840660
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number00G840660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: