Provider Demographics
NPI:1821528480
Name:NOTTINGHAM, BRAXTON LANE (MD)
Entity Type:Individual
Prefix:
First Name:BRAXTON
Middle Name:LANE
Last Name:NOTTINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:405-669-2600
Mailing Address - Fax:405-500-1232
Practice Address - Street 1:2557 OLD TIMBERS DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9813
Practice Address - Country:US
Practice Address - Phone:405-669-2600
Practice Address - Fax:405-500-1232
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine