Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 32002 | TN |
NPI | 1033176250 |
---|---|
Provider Name | Dr. Robert Bradley Canada |
First Address | Memphis, TN 38104-3641 |
Second Address | Memphis, TN 38104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 01/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00122642 | (05) | MS |
003181471A | (05) | GA |
1033176250 | (05) | MO |
140694001 | (05) | AR |
7100458660 | (05) | KY |
H16624 | (02) | |
Q003696 | (05) | TN |