Provider Demographics
NPI:1528175262
Name:BRATTON, RICHARD DIX JR (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DIX
Last Name:BRATTON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1277 E CEDAR AVE
Mailing Address - Street 2:P.O. BOX 685
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-7004
Mailing Address - Country:US
Mailing Address - Phone:989-426-3689
Mailing Address - Fax:989-426-3694
Practice Address - Street 1:1277 E CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-7004
Practice Address - Country:US
Practice Address - Phone:989-426-3689
Practice Address - Fax:989-426-3694
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007782208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0152616155OtherBLUE CLOSS & BLUE SHIELD
MI114726246Medicaid
MI0152616155OtherBLUE CLOSS & BLUE SHIELD
MIE26548Medicare UPIN