Provider Demographics
NPI:1649282112
Name:BRATTON, EDWARD E (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:BRATTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10746 FIREBRICK CT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5031
Mailing Address - Country:US
Mailing Address - Phone:727-455-5613
Mailing Address - Fax:727-372-1402
Practice Address - Street 1:10746 FIREBRICK CT
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5031
Practice Address - Country:US
Practice Address - Phone:727-455-5613
Practice Address - Fax:727-372-1402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01421213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87755GOtherMCARE PTAN FOR HILLS & PINELLAS
FL480031838OtherRAILROAD MEDICARE
FLPO1421OtherMEDICAL LICENSE
FL285934OtherWELLCARE
FL041177900Medicaid
FL87755HOtherMCARE PTAN FOR PASCO
FL480031838OtherRAILROAD MEDICARE
FL87755GOtherMCARE PTAN FOR HILLS & PINELLAS