Individual
DR. THOMAS MARK BRAXTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1194
(270) 251-4085
Mailing address
595 STATE ROUTE 408 E, HICKORY, KY 42051-9537
(270) 804-9727
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
43065
TN
207P00000X
Emergency Medicine Physician
43829
KY
207Q00000X
Family Medicine Physician
43065
TN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
43829
KY
208D00000X
General Practice Physician
00024642
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100157640
—
KY
Enumeration date
02/27/2006
Last updated
03/07/2015
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