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General NPI Number Information
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NPI Number | 1902688138
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Entity Type | Individual
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Provider Name | BRAXTON PORTER
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Gender | Male
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 435 W CRYSTAL ST. SUITE 300
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City | BUTTE
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State | MT
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Zip | 59701
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Country | US
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Telephone | 406-496-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 W PARK ST
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City | BUTTE
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State | MT
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Zip | 59701-9073
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Country | US
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Telephone | 801-866-4791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 148617
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License Number State | MT
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