Provider Demographics
NPI:1689697336
Name:BRADEN, DAVID STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:STEVEN
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 1:624 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2337
Mailing Address - Country:US
Mailing Address - Phone:601-835-2100
Mailing Address - Fax:601-835-0451
Practice Address - Street 1:624 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2337
Practice Address - Country:US
Practice Address - Phone:601-835-2100
Practice Address - Fax:601-835-0451
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS107592080P0202X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121920Medicaid
MSD44905Medicare UPIN
MS370000342Medicare PIN