Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A26095 | CA |
NPI | 1386756724 |
---|---|
Provider Name | Gary W Bradley |
First Address | Santa Barbara, CA 93101 |
Second Address | Santa Barbara, CA 93101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 30/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24722 | (02) | CA |