MEDICARE: DR. FRANK W BRAXTON M.D.

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	207RN0300X	Nephrology Physician	MD018849E	PA
2	207RN0300X	Nephrology Physician	036-074275	IL
3	207RN0300X	Nephrology Physician	D0021892	MD
4	207RN0300X	Nephrology Physician	R9D58	MO
5	207RN0300X	Nephrology Physician	N-8307	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110179816	OTHER		RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1370190	OTHER		COVENTRY HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	149786	OTHER	MO	HEALTHLINK
6	5J228	OTHER	AR	BLUE CROSS BLUE SHIELD
7	096561	OTHER		HEALTH ALLIANCE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	4430	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1639120389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK W BRAXTON M.D.

Provider Business Mailing Address
First Line	:	1349 N MOUNT AUBURN RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-1727
Country	:	US
Telephone Number	:	573-334-9564
Fax Number	:	573-334-1879

Provider Business Practice Location Address
First Line	:	1349 N MOUNT AUBURN RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-1727
Country	:	US
Telephone Number	:	573-334-9564
Fax Number	:	573-334-1879

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	10/20/2020

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1349 N MOUNT AUBURN RD
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1861505703 — DAVID Y LEE MD
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1649365917 — ROBERT EARL GARDNER JR. MD
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