Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | L0043 | TX |
Y | 207XS0117X | Orthopaedic Spine Surgeon | M-13237 | ID |
NPI | 1245273382 |
---|---|
Provider Name | William Daniel Bradley |
First Address | Nampa, ID 83686-6011 |
Second Address | Nampa, ID 83686-6011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 20/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0405045-01 | (05) | TX |
H25888 | (02) | TX |