Healthcare Provider Details

I. General information

NPI: 1932248960
Provider Name (Legal Business Name): BRADLEY BLAIR VEAZEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S COULTER ST
AMARILLO TX
79106-1836
US

IV. Provider business mailing address

1100 S COULTER ST
AMARILLO TX
79106-1836
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2006-0451
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: