Healthcare Provider Details

I. General information

NPI: 1952363715
Provider Name (Legal Business Name): BRADLEY H WERRELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 S HOSPITAL DR
GLOBE AZ
85501-9462
US

IV. Provider business mailing address

PO BOX 2509
GLOBE AZ
85502-2509
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-8151
  • Fax: 928-425-9425
Mailing address:
  • Phone: 928-425-8151
  • Fax: 928-425-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4540
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number4540
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34007912
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number34007912
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: