Healthcare Provider Details

I. General information

NPI: 1316929466
Provider Name (Legal Business Name): BRADLEY KENT HEIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 ROSS CLARK CIR STE 402
DOTHAN AL
36301-3002
US

IV. Provider business mailing address

1118 ROSS CLARK CIR STE 402
DOTHAN AL
36301-3002
US

V. Phone/Fax

Practice location:
  • Phone: 334-673-3633
  • Fax: 334-836-2894
Mailing address:
  • Phone: 334-673-3633
  • Fax: 334-836-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number23479
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: