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General NPI Number Information
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NPI Number | 1013001544
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Entity Type | Individual
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Provider Name | BRADFORD STEELE MARTIN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 2500 NORTH STATE STREET DEPARTMENT OF ORTHOPEDICS
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City | JACKSON
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State | MS
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Zip | 39216-4505
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Country | US
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Telephone | 601-815-3045
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11407 DEPT 2130 STATE OF MS-UNIVERSITY OF MS MEDICAL CENTER
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City | BIRMINGHAM
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State | AL
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Zip | 35246-2130
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Country | US
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Telephone | 601-984-6426
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Fax | 601-984-6439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R850364
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R850364
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License Number State | MS
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