Provider Demographics
NPI:1366425563
Name:BRATTON, ROBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:BRATTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 LAKECREST CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1707
Mailing Address - Country:US
Mailing Address - Phone:859-258-8600
Mailing Address - Fax:859-258-8610
Practice Address - Street 1:3085 LAKECREST CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1707
Practice Address - Country:US
Practice Address - Phone:859-258-8600
Practice Address - Fax:859-258-8610
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33458207Q00000X
KY42325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ916504Medicaid
AZP00216350OtherRAILROAD MEDICARE
AZ86080015085259A281OtherTRIWEST
AZ86080015085259A281OtherTRIWEST
E90885Medicare UPIN
AZZ101663Medicare PIN