Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | ME61738 | FL |
NPI | 1003836362 |
---|---|
Provider Name | Walter G Bradley |
First Address | Miami, FL 33136-1002 |
Second Address | Miami, FL 33136-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B97506 | (02) | FL |