Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1525 | SC |
NPI | 1447255732 |
---|---|
Provider Name | Dr. Brad Eric Fraum |
First Address | Hilton Head Island, SC 29926-1654 |
Second Address | Hilton Head Island, SC 29926-1654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 08/07/2007 |