Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1740517937 |
---|---|
Provider Name | Mr. David R Bradshaw |
First Address | Union Grove, NC 28689-0103 |
Second Address | Union Grove, NC 28689-9049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2009 |
Last Update Date | 09/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7703861 | (05) | NC |