Healthcare Provider Details

I. General information

NPI: 1710063169
Provider Name (Legal Business Name): JAMES BRADFORD BRAUDIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 02/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 GAINESWAY DR
LEXINGTON KY
40517-2813
US

IV. Provider business mailing address

PO BOX 24945
LEXINGTON KY
40524-4945
US

V. Phone/Fax

Practice location:
  • Phone: 859-576-1524
  • Fax:
Mailing address:
  • Phone: 859-576-1524
  • Fax: 859-271-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00140
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number00140
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: