Provider Demographics
NPI:1922050095
Name:BRAKER, MARTIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:BRAKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:1455 MONTEGO
Practice Address - Street 2:SUITE 207
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2990
Practice Address - Country:US
Practice Address - Phone:925-937-4057
Practice Address - Fax:925-937-4061
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG15523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G155230Medicaid
CA00G155231Medicare PIN
CAP00103581Medicare PIN
CAA39556Medicare UPIN