Provider Demographics
NPI:1447223060
Name:BRADEN, LAWRENCE F (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:F
Last Name:BRADEN
Suffix:
Gender:M
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:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71711-0757
Mailing Address - Country:US
Mailing Address - Phone:870-836-8101
Mailing Address - Fax:
Practice Address - Street 1:353 CASH RD SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3704
Practice Address - Country:US
Practice Address - Phone:870-836-8101
Practice Address - Fax:870-837-6833
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000167122306OtherUNITED HEALTH CARE
AR770078401OtherBREASTCARE
AR13271000000OtherQUALCHOICE
AR080070820OtherRAILROAD MEDICARE
AR101351001Medicaid
5271038OtherAETNA
AR13271000000OtherQUALCHOICE
5271038OtherAETNA