Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1417066234 |
---|---|
Provider Name | Mark A Bratton |
First Address | Fresno, CA 93726-6923 |
Second Address | Fresno, CA 93726-6923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XC0024770 | (05) | CA |