Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 7238 | NE |
Y | 208600000X | Surgeon | 7238 | NE |
NPI | 1003220948 |
---|---|
Provider Name | Bradley Hall |
First Address | Omaha, NE 68198-3280 |
Second Address | Omaha, NE 68198-3280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2014 |
Last Update Date | 18/06/2014 |