Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 35-64786 | OH |
NPI | 1083611420 |
---|---|
Provider Name | Brian S Bradley |
First Address | Toledo, OH 43606-0098 |
Second Address | Toledo, OH 43606-3895 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 11/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000129749 | ANTHEM BLUE CROSS (01) | OH |
0913499 | (05) | OH |
10256 | PARAMOUNT (01) | OH |
2031651 | AETNA (01) | OH |
2922614 | (05) | MI |
47-00071 | UNITED HEALTH CARE (01) | OH |