Individual
DR. KENT THOMAS BRAEUTIGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3839 COUNTY ROAD 218, MIDDLEBURG, FL 32068-5708
(904) 282-5474
(904) 282-5824
Mailing address
705 WELLS RD STE 300, ORANGE PARK, FL 32073-2982
(904) 282-6331
(904) 282-4117
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS5110
FL
208D00000X
General Practice Physician
Primary
OS5110
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046178400
—
FL
Enumeration date
07/13/2006
Last updated
09/15/2022
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