Healthcare Provider Details

I. General information

NPI: 1275701997
Provider Name (Legal Business Name): BRADY MEDICAL CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 EXCHANGE STREET SUITE 150
ASTORIA OR
97103-3419
US

IV. Provider business mailing address

2095 EXCHANGE STREET SUITE 150
ASTORIA OR
97103-3419
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-7546
  • Fax: 503-325-7343
Mailing address:
  • Phone: 503-325-7546
  • Fax: 503-325-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD10611
License Number StateOR

VIII. Authorized Official

Name: DR. RAYMOND E BRADY III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 503-325-7546