Provider Demographics
NPI:1811128275
Name:BRAYTON, KIMBERLY BRAYTON (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BRAYTON
Last Name:BRAYTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3648
Mailing Address - Country:US
Mailing Address - Phone:707-573-6166
Mailing Address - Fax:707-573-6165
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:STE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3648
Practice Address - Country:US
Practice Address - Phone:707-573-6166
Practice Address - Fax:707-573-6165
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106242207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01609287OtherRAILROAD MEDICARE
CA0A1062420OtherBLUE SHIELD OF CALIFORNIA
CACA187165Medicare PIN