Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 125-042665 | IL |
NPI | 1265654636 |
---|---|
Provider Name | Bradley Medling |
First Address | Murfreesboro, TN 37129-2570 |
Second Address | Murfreesboro, TN 37129-2570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 23/04/2009 |