Basic Information
| Provider Information | |||||||||
| NPI: | 1134507957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAATEN | ||||||||
| FirstName: | TYLER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20114 WIDE CREEK CT | ||||||||
| Address2: | |||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774496317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186057665 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6431 FANNIN ST | ||||||||
| Address2: | SUITE MSB 2.025 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007583 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2015 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | BP10054300 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2085R0202X | BP20057351 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.