Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 4340 | OK |
Y | 207Q00000X | Family Doctor | 05-32073 | KS |
N | 207QS0010X | Family Doctor - Sports Medicine | 4340 | OK |
NPI | 1043252158 |
---|---|
Provider Name | Dr. Bradley K Warrick |
First Address | Leavenworth, KS 66048-5009 |
Second Address | Stillwater, OK 74078-2000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 29/05/2018 |