Healthcare Provider Details

I. General information

NPI: 1346293081
Provider Name (Legal Business Name): STEPHEN A BRADEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E 29TH ST
BRYAN TX
77802
US

IV. Provider business mailing address

2800 S TEXAS AVE SUITE 202
BRYAN TX
77802-5361
US

V. Phone/Fax

Practice location:
  • Phone: 979-821-6300
  • Fax: 979-823-4543
Mailing address:
  • Phone: 979-774-2060
  • Fax: 979-776-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3773
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: