Healthcare Provider Details

I. General information

NPI: 1154382513
Provider Name (Legal Business Name): JOHN BRADY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 US HIGHWAY 18 E
CLEAR LAKE IA
50428-2162
US

IV. Provider business mailing address

1801 US HIGHWAY 18 E
CLEAR LAKE IA
50428-2162
US

V. Phone/Fax

Practice location:
  • Phone: 641-357-1999
  • Fax: 641-357-1997
Mailing address:
  • Phone: 641-357-1999
  • Fax: 641-357-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02940
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: