Healthcare Provider Details

I. General information

NPI: 1013001544
Provider Name (Legal Business Name): BRADFORD STEELE MARTIN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET DEPARTMENT OF ORTHOPEDICS
JACKSON MS
39216-4505
US

IV. Provider business mailing address

PO BOX 11407 DEPT 2130 STATE OF MS-UNIVERSITY OF MS MEDICAL CENTER
BIRMINGHAM AL
35246-2130
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-3045
  • Fax:
Mailing address:
  • Phone: 601-984-6426
  • Fax: 601-984-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR850364
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR850364
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: