Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME87576 | FL |
NPI | 1851394746 |
---|---|
Provider Name | Dr. Timothy Michael Bradley |
First Address | Brandon, FL 33511-5900 |
Second Address | Brandon, FL 33511-5900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 28/11/2014 |