Provider Demographics
NPI:1871594010
Name:BRAYE, EDWARD TILDON JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:TILDON
Last Name:BRAYE
Suffix:JR
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 1:8765 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8011
Mailing Address - Country:US
Mailing Address - Phone:409-727-6000
Mailing Address - Fax:409-727-6622
Practice Address - Street 1:8765 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8011
Practice Address - Country:US
Practice Address - Phone:409-727-6000
Practice Address - Fax:409-727-6622
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8581208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B327Medicare ID - Type Unspecified
C13731Medicare UPIN