Healthcare Provider Details

I. General information

NPI: 1568049724
Provider Name (Legal Business Name): BRADLEY WILLIAM GANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 W SAMPLE RD
CORAL SPRINGS FL
33065-4001
US

IV. Provider business mailing address

2710 W ATLANTIC AVE
DELRAY BEACH FL
33445-4431
US

V. Phone/Fax

Practice location:
  • Phone: 754-206-1877
  • Fax: 754-229-3866
Mailing address:
  • Phone: 754-206-1877
  • Fax: 754-229-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS22120
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS22120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: