Healthcare Provider Details

I. General information

NPI: 1841278231
Provider Name (Legal Business Name): CHARLES BRAUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST SAN JUAN REGIONAL MEDICAL CENTER / HOSPITALISTS
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

PO BOX 6210
FARMINGTON NM
87499-6210
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6463
  • Fax:
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number82-15
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number82-15
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: