Healthcare Provider Details

I. General information

NPI: 1902184948
Provider Name (Legal Business Name): BRADLEY COLE KIRKPATRICK H.A.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3832 BAYMEADOWS RD STE 7
JACKSONVILLE FL
32217-5605
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 904-683-6923
  • Fax: 904-683-6936
Mailing address:
  • Phone: 630-303-5380
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: