Provider Demographics
NPI:1063077162
Name:MATTISON, BRADEN JAMES (MD)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:JAMES
Last Name:MATTISON
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 1:9321 W SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4845
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:702-650-0865
Practice Address - Street 1:9321 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4845
Practice Address - Country:US
Practice Address - Phone:702-645-7800
Practice Address - Fax:702-650-0865
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME167383207X00000X
NV27607207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery