Provider Demographics
NPI:1508041781
Name:EDWARD E BRATTON DPM
Entity Type:Organization
Organization Name:EDWARD E BRATTON DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-572-5449
Mailing Address - Street 1:12180 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1820
Mailing Address - Country:US
Mailing Address - Phone:727-572-5449
Mailing Address - Fax:
Practice Address - Street 1:13131 66TH ST N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1812
Practice Address - Country:US
Practice Address - Phone:727-455-5613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01421213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041177900Medicaid
FLT85782Medicare UPIN
FL3970680001Medicare NSC
FL87755Medicare PIN
FL480031838Medicare PIN