Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35069757 | OH |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35069757 | OH |
NPI | 1114919479 |
---|---|
Provider Name | Dr. Brad E Brautigan |
First Address | Zanesville, OH 43701-1721 |
Second Address | Zanesville, OH 43701-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 12/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2179646 | (05) | OH |
H11860 | (02) | OH |