Provider Demographics
NPI:1689416281
Name:BRATCHER, BRAXTON CHASE
Entity type:Individual
Prefix:
First Name:BRAXTON
Middle Name:CHASE
Last Name:BRATCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-1620
Mailing Address - Country:US
Mailing Address - Phone:405-537-5985
Mailing Address - Fax:
Practice Address - Street 1:1100 N STONEWALL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1200
Practice Address - Country:US
Practice Address - Phone:405-271-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program