MEDICARE: JEFFREY M BRAXTON M.D., F.A.C.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036084373	IL
2	208600000X	Surgery Physician	56713	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K50963	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1053415257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M BRAXTON M.D., F.A.C.S.

Provider Business Mailing Address
First Line	:	6301 S MCCLINTOCK DR STE 115
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-3393
Country	:	US
Telephone Number	:	480-775-8460
Fax Number	:	480-775-8464

Provider Business Practice Location Address
First Line	:	535 E MCKELLIPS RD STE 111
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-2525
Country	:	US
Telephone Number	:	480-510-3079
Fax Number	:	480-779-1277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	05/21/2025

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