Healthcare Provider Details

I. General information

NPI: 1447223060
Provider Name (Legal Business Name): LAWRENCE F BRADEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 CASH RD SW
CAMDEN AR
71701-3704
US

IV. Provider business mailing address

PO BOX 757
CAMDEN AR
71711-0757
US

V. Phone/Fax

Practice location:
  • Phone: 870-836-8101
  • Fax: 870-837-6833
Mailing address:
  • Phone: 870-836-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC5811
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: