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General NPI Number Information
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NPI Number | 1275701997
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Entity Type | Organization
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Legal Business Name | BRADY MEDICAL CONSULTANTS, PLLC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 2095 EXCHANGE STREET SUITE 150
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City | ASTORIA
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State | OR
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Zip | 97103-3419
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Country | US
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Telephone | 503-325-7546
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Fax | 503-325-7343
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Provider Business Mailing Address
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Address Line | 2095 EXCHANGE STREET SUITE 150
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City | ASTORIA
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State | OR
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Zip | 97103-3419
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Country | US
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Telephone | 503-325-7546
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Fax | 503-325-7343
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYMOND E BRADY III
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Credential | M.D.
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Telephone | 503-325-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD10611
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License Number State | OR
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