Provider Demographics
NPI:1427157700
Name:BRAXTON, CARLA C (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:C
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18400 KATY FWY
Mailing Address - Street 2:SUITE 560
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1286
Mailing Address - Country:US
Mailing Address - Phone:832-522-3240
Mailing Address - Fax:
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:SUITE 560
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1286
Practice Address - Country:US
Practice Address - Phone:832-522-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29699208600000X, 2086S0102X
TXP8222208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100425270AMedicaid
MO205913908Medicaid
KS436730OtherFIRSTGUARD
TX8GD827OtherBCBS
TX339836404Medicaid
TX339836403Medicaid
TX8FB774OtherBLUE CROSS BLUE SHIELD
MO31519012OtherBCBS KANSAS CITY
MO31519012OtherBCBS KANSAS CITY
TX8FB774OtherBLUE CROSS BLUE SHIELD
KS100425270AMedicaid