Provider Demographics
NPI:1891852091
Name:BRAUN, RANDELL I (DPM)
Entity Type:Individual
Prefix:DR
First Name:RANDELL
Middle Name:I
Last Name:BRAUN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4371
Mailing Address - Country:US
Mailing Address - Phone:251-626-5065
Mailing Address - Fax:251-626-7580
Practice Address - Street 1:1913 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4371
Practice Address - Country:US
Practice Address - Phone:251-626-5065
Practice Address - Fax:251-626-7580
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL82213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1891852091Medicare NSC
AL000073814Medicare PIN