Healthcare Provider Details

I. General information

NPI: 1982960985
Provider Name (Legal Business Name): BRADLEY C KNOX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST DEPT OF EM: INPT TOWER ROOM C1A100
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

2051 MARENGO ST DEPT OF EM: INPT TOWER ROOM C1A100
LOS ANGELES CA
90033-1352
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-1945
  • Fax:
Mailing address:
  • Phone: 323-409-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA120640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: