Healthcare Provider Details

I. General information

NPI: 1093082737
Provider Name (Legal Business Name): BRADLEY C POFF DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 SOUTHRIDGE AVE
EAGAN MN
55121-1128
US

IV. Provider business mailing address

1468 SOUTHRIDGE AVE
EAGAN MN
55121-1128
US

V. Phone/Fax

Practice location:
  • Phone: 978-790-2226
  • Fax:
Mailing address:
  • Phone: 978-790-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number13588
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: