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General NPI Number Information
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NPI Number | 1588845259
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Entity Type | Organization
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Legal Business Name | NEPHROLOGY ASSOCIATES, PC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 1409 E MOULTRIE DR
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-6855
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Country | US
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Telephone | 870-776-1464
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Fax | 870-776-1474
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Provider Business Mailing Address
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Address Line | 1349 N MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-1727
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Country | US
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Telephone | 573-334-9564
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Fax | 573-334-1879
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. FRANK W BRAXTON
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Credential | M.D.
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Telephone | 573-334-9564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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