Healthcare Provider Details

I. General information

NPI: 1659319721
Provider Name (Legal Business Name): BRADFORD MARTIN FINE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD C115
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

1401 HARRODSBURG RD C115
LEXINGTON KY
40504-3751
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-8855
  • Fax: 859-278-8856
Mailing address:
  • Phone: 859-278-8855
  • Fax: 859-278-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00313
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3163
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00313
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: