Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 24173 | TX |
Y | 103TC0700X | Clinical Psychologist | 24173 | TX |
NPI | 1013131911 |
---|---|
Provider Name | Dr. David T. Bradford |
First Address | Austin, TX 78703-4136 |
Second Address | Austin, TX 78746-5523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |