Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD31444 | TN |
NPI | 1003888082 |
---|---|
Provider Name | Melita Melson Bradley |
First Address | Murfreesboro, TN 37127-6382 |
Second Address | Murfreesboro, TN 37127-6382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 25/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G87711 | (02) |