Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 00G840660 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 00G840660 | CA |
NPI | 1538117056 |
---|---|
Provider Name | Paul J Braaton |
First Address | Modesto, CA 95355-3192 |
Second Address | Modesto, CA 95355-3192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 11/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G840660 | (05) | CA |
F36158 | (02) |