Healthcare Provider Details

I. General information

NPI: 1104056530
Provider Name (Legal Business Name): BRADLEY B VEAZEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 TULE DR SUITE 129
AMARILLO TX
79108-6942
US

IV. Provider business mailing address

8301 TULE DR SUITE 129
AMARILLO TX
79108-6942
US

V. Phone/Fax

Practice location:
  • Phone: 806-467-9700
  • Fax: 806-468-9771
Mailing address:
  • Phone: 806-467-9700
  • Fax: 806-468-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM2852
License Number StateTX

VIII. Authorized Official

Name: DR. BRADLEY VEAZEY
Title or Position: OWNER
Credential: MD
Phone: 806-468-9700