Basic Information
| Provider Information | |||||||||
| NPI: | 1508819590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAATEN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | MERLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1233 N 18TH ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254373687 | ||||||||
| FaxNumber: | 3254371827 | ||||||||
| Practice Location | |||||||||
| Address1: | 1233 N 18TH ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254373687 | ||||||||
| FaxNumber: | 3254371827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | H2048 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 109019100 | 01 | TX | FIRST CARE | OTHER | 123014 | 01 | TX | SUPERIOR | OTHER | 110138414 | 01 | TX | RR MEDICARE | OTHER | 126524103 | 05 | TX | MEDICAID |