1427157700 NPI number — DR. CARLA C BRAXTON MD

Table of content: DR. CARLA C BRAXTON MD (NPI 1427157700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427157700 NPI number — DR. CARLA C BRAXTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAXTON
Provider First Name:
CARLA
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427157700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18400 KATY FWY
Provider Second Line Business Mailing Address:
SUITE 560
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77094-1286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-522-3240
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18400 KATY FWY
Provider Second Line Business Practice Location Address:
SUITE 560
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77094-1286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-522-3240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  04-29699 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0102X , with the licence number: 04-29699 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: P8222 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100425270A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205913908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 436730 . This is a "FIRSTGUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 8GD827 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 339836404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 339836403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8FB774 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 31519012 . This is a "BCBS KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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