Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 30436 | AZ |
NPI | 1154315810 |
---|---|
Provider Name | Dr. Kevin M Brady |
First Address | Phoenix, AZ 85028-6069 |
Second Address | Phoenix, AZ 85028-6069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 16/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H63811 | (02) | AZ |