Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 1258368 | TX |
NPI | 1043831571 |
---|---|
Provider Name | David Bradley |
First Address | Dallas, TX 75201-1135 |
Second Address | Dallas, TX 75235-7709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2020 |
Last Update Date | 06/05/2020 |