Provider Demographics
NPI:1962402081
Name:BRATTON, ANGELA RENEE (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:BRATTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-246-2622
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:1623 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3018
Practice Address - Country:US
Practice Address - Phone:505-662-5444
Practice Address - Fax:505-662-6109
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-219207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM003195OtherBC BS OF NM
NM05676Medicaid
E10491Medicare UPIN