Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME134278 | FL |
NPI | 1144735945 |
---|---|
Provider Name | Judith Watson Bradfield |
First Address | Port St Lucie, FL 34986-3035 |
Second Address | Port St Lucie, FL 34986-3035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2017 |
Last Update Date | 04/12/2017 |