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General NPI Number Information
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NPI Number | 1184995987
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Entity Type | Individual
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Provider Name | ROBERT BRADY MD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR DEPT OF
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-916-2956
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Fax | 210-916-3235
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Provider Business Mailing Address
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Address Line | 3551 ROGER BROOKE DR DEPT OF
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-539-9582
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 0101249656
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207ZP0213X
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Taxonomy Name | Pediatric Pathology Physician
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License Number | S2735
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | S2735
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License Number State | TX
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