Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 019025787 | IL |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2002000301 | MO |
NPI | 1770562068 |
---|---|
Provider Name | Dr. Bradley Alan Seyer |
First Address | Bridgeton, MO 63044-2604 |
Second Address | Bridgeton, MO 63044-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 26/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U97967 | (02) | MO |