Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD2014-0229 | NM |
NPI | 1114244514 |
---|---|
Provider Name | Bradley Holbrook |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106-2719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2010 |
Last Update Date | 22/03/2017 |