Healthcare Provider Details

I. General information

NPI: 1528179363
Provider Name (Legal Business Name): JOHN BRAYTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 DELNOR DR
GENEVA IL
60134
US

IV. Provider business mailing address

25 N WINFIELD RD
WINFIELD IL
60190-1295
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4056
  • Fax:
Mailing address:
  • Phone: 630-933-4056
  • Fax: 630-933-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036094318
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: