Provider Demographics
NPI:1861680795
Name:PAUL J BRAATON, M.D., INC.
Entity Type:Organization
Organization Name:PAUL J BRAATON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-524-5977
Mailing Address - Street 1:1335 COFFEE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3188
Mailing Address - Country:US
Mailing Address - Phone:209-524-5977
Mailing Address - Fax:209-524-7395
Practice Address - Street 1:1335 COFFEE RD STE 100
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3192
Practice Address - Country:US
Practice Address - Phone:209-524-5977
Practice Address - Fax:209-524-7395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G840660Medicaid
CA00G840660Medicaid
CAF36158Medicare UPIN