Provider Demographics
NPI:1508819590
Name:BRAATEN, JEFFREY MERLE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MERLE
Last Name:BRAATEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2932
Mailing Address - Country:US
Mailing Address - Phone:325-437-3687
Mailing Address - Fax:325-437-1827
Practice Address - Street 1:1233 N 18TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2932
Practice Address - Country:US
Practice Address - Phone:325-437-3687
Practice Address - Fax:325-437-1827
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2048207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109019100OtherFIRST CARE
TX123014OtherSUPERIOR
TX110138414OtherRR MEDICARE
TX126524103Medicaid
TX123014OtherSUPERIOR
TX109019100OtherFIRST CARE