Healthcare Provider Details

I. General information

NPI: 1881011351
Provider Name (Legal Business Name): BRADEN EDWARD HARTLINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2014
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 PINECROFT DR STE 400
THE WOODLANDS TX
77380-3482
US

IV. Provider business mailing address

6400 FANNIN ST
HOUSTON TX
77030-1521
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-8800
  • Fax: 281-367-1323
Mailing address:
  • Phone: 713-486-7500
  • Fax: 716-512-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberS0896
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberS0896
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: