Healthcare Provider Details

I. General information

NPI: 1447486113
Provider Name (Legal Business Name): BRADLEY ROBERT POLLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY # U107
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

PO BOX 11167
KNOXVILLE TN
37939-1167
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9661
  • Fax: 865-305-6148
Mailing address:
  • Phone: 865-584-7376
  • Fax: 865-540-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101248124
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number52558
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number52558
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: