Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1992214670 |
---|---|
Provider Name | Jacob Bradford |
First Address | Midland, TX 79705-3276 |
Second Address | Midland, TX 79705-3276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2017 |
Last Update Date | 25/09/2017 |