Healthcare Provider Details

I. General information

NPI: 1609836048
Provider Name (Legal Business Name): KENT LORING BRADLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER
APO AE
09180
US

IV. Provider business mailing address

LRMC, CMR 402 BOX 1779
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 637-186-6199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number31900024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: