Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 15663 | AZ |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 15663 | AZ |
NPI | 1356342224 |
---|---|
Provider Name | Bradley J Brainard |
First Address | Tucson, AZ 85751-1630 |
Second Address | Tucson, AZ 85712-6115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 06/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E82224 | (02) | AZ |