Doctor Name: | ROBERT W BRADLEY |
NPI Number: | 1003084914 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | PA03045 |
Business Practice Address: | Cmr 442 Apo, AE - 09042 |
Business Phone Number: | 6221172274 |
Business Fax Number: | |
Mailing Address: | Cmr 442, APO |
State: | AE |
Postal Code: | 09042 |
Phone Number: | 6221172274 |
Fax Number: | |
NPI Enumeration Date: | 02/13/2008 |
NPI Last Update Date: | 02/13/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA03045 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |