Provider Demographics
NPI:1881011351
Name:HARTLINE, BRADEN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:EDWARD
Last Name:HARTLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6400 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1521
Mailing Address - Country:US
Mailing Address - Phone:713-486-7500
Mailing Address - Fax:716-512-7240
Practice Address - Street 1:9305 PINECROFT DR STE 400
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3482
Practice Address - Country:US
Practice Address - Phone:713-486-8800
Practice Address - Fax:281-367-1323
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-23
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0896207X00000X, 207XS0114X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program