Healthcare Provider Details

I. General information

NPI: 1699228973
Provider Name (Legal Business Name): BRAD VESTAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 BELLAIRE BLVD
BELLAIRE TX
77401-3901
US

IV. Provider business mailing address

900 8TH ST STE 520
WICHITA FALLS TX
76301-6801
US

V. Phone/Fax

Practice location:
  • Phone: 713-666-1704
  • Fax: 713-666-1184
Mailing address:
  • Phone: 940-228-4870
  • Fax: 940-228-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80341
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: