Provider Demographics
NPI:1730475419
Name:MOORE, BRADEN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:J
Last Name:MOORE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2010 W KATHERINE P RAINES RD
Mailing Address - Street 2:STE 300
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7435
Mailing Address - Country:US
Mailing Address - Phone:817-556-3212
Mailing Address - Fax:817-556-2388
Practice Address - Street 1:2010 W KATHERINE P RAINES RD
Practice Address - Street 2:STE 300
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7435
Practice Address - Country:US
Practice Address - Phone:817-556-3212
Practice Address - Fax:817-556-2388
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2077213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
354317ZHBAMedicare PIN