Provider Demographics
NPI:1639120389
Name:BRAXTON, FRANK W (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:W
Last Name:BRAXTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1349 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1727
Mailing Address - Country:US
Mailing Address - Phone:573-334-9564
Mailing Address - Fax:573-334-1879
Practice Address - Street 1:1349 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1727
Practice Address - Country:US
Practice Address - Phone:573-334-9564
Practice Address - Fax:573-334-1879
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD018849E207RN0300X
IL036-074275207RN0300X
MDD0021892207RN0300X
MOR9D58207RN0300X
ARN-8307207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110164001Medicaid
110179816OtherRAIL ROAD MEDICARE
1370190OtherCOVENTRY HEALTHCARE
MO202071478Medicaid
MO149786OtherHEALTHLINK
AR5J228OtherBLUE CROSS BLUE SHIELD
096561OtherHEALTH ALLIANCE
MO209765221Medicaid
MO4430OtherBLUE CROSS BLUE SHIELD