Provider Demographics
NPI:1710063169
Name:BRAUDIS, JAMES BRADFORD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRADFORD
Last Name:BRAUDIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24945
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40524-4945
Mailing Address - Country:US
Mailing Address - Phone:859-576-1524
Mailing Address - Fax:859-271-1444
Practice Address - Street 1:1236 GAINESWAY DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-2813
Practice Address - Country:US
Practice Address - Phone:859-576-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00140213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80900095Medicaid
KYT54191Medicare UPIN
KY2018101Medicare ID - Type Unspecified