Organization Name: | BRADLEY W NORDYKE MD |
NPI Number: | 1609925312 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRADLEY W NORDYKE (OWNER) |
Mailing Address: | 3914 Paredes Line Rd Brownsville |
State: | TX US |
Postal Code: | 785261184 |
Phone Number: | 9569821696 |
Fax Number: | 9569822256 |
NPI Enumeration Date: | 01/10/2007 |
NPI Last Update Date: | 07/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | J7115 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |