Provider Demographics
NPI:1275626988
Name:BRADEN RICHMOND, MD,PC
Entity Type:Organization
Organization Name:BRADEN RICHMOND, MD,PC
Other - Org Name:BRADEN RICHMOND, MD,PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:BRADEN
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-435-2229
Mailing Address - Street 1:731 LEIGHTON AVENUE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5766
Mailing Address - Country:US
Mailing Address - Phone:256-435-2229
Mailing Address - Fax:256-782-2904
Practice Address - Street 1:731 LEIGHTON AVENUE
Practice Address - Street 2:SUITE 401
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5766
Practice Address - Country:US
Practice Address - Phone:256-435-2229
Practice Address - Fax:256-782-2904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADEN RICHMOND MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19452207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503068Medicaid
AL051503068Medicaid
AL051503068Medicare ID - Type Unspecified