Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD12438 | RI |
N | 207X00000X | Orthopaedic Surgeon | MD434563 | PA |
N | 207XS0106X | Orthopaedic Hand Surgeon | MD12438 | RI |
N | 207XS0106X | Orthopaedic Hand Surgeon | MD434563 | PA |
NPI | 1164430856 |
---|---|
Provider Name | Dr. Gwynne A Bragdon |
First Address | Providence, RI 02901-1119 |
Second Address | Middletown, RI 02842-5236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/02/2019 |