Healthcare Provider Details

I. General information

NPI: 1700971967
Provider Name (Legal Business Name): BRADLEY PHILLIP FUHRMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 ALBERTA AVE DEPARTMENT OF PEDIATRICS
EL PASO TX
79905-2709
US

IV. Provider business mailing address

4800 ALBERTA AVE DEPARTMENT OF PEDIATRICS
EL PASO TX
79905-2709
US

V. Phone/Fax

Practice location:
  • Phone: 915-545-6921
  • Fax: 915-545-6992
Mailing address:
  • Phone: 915-545-6921
  • Fax: 915-545-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number185870
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number44071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: