=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366425563
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT L BRATTON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2005
-----------------------------------------------------
Last Update Date | 03/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3085 LAKECREST CIR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40513-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-258-8600
-----------------------------------------------------
Fax | 859-258-8610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3085 LAKECREST CIR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40513-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-258-8600
-----------------------------------------------------
Fax | 859-258-8610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 33458
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 42325
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------