Healthcare Provider Details

I. General information

NPI: 1285631382
Provider Name (Legal Business Name): BRADLEY P TODD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3367 GALT OCEAN DRIVE
FORT LAUDERDALE FL
33308-7002
US

IV. Provider business mailing address

3367 GALT OCEAN DRIVE
FORT LAUDERDALE FL
33308-5968
US

V. Phone/Fax

Practice location:
  • Phone: 954-566-2580
  • Fax: 954-566-8929
Mailing address:
  • Phone: 954-566-2580
  • Fax: 954-566-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 3045
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO 3045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: