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General NPI Number Information
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NPI Number | 1295909604
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Entity Type | Organization
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Legal Business Name | BRADLEY HOUSTON M.D.
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 605 E MAIN ST
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City | OLNEY
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State | IL
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Zip | 62450-2163
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Country | US
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Telephone | 618-392-2940
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Fax | 618-392-7225
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Provider Business Mailing Address
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Address Line | 605 E MAIN ST
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City | OLNEY
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State | IL
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Zip | 62450-2163
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Country | US
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Telephone | 618-392-2940
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Fax | 618-392-7225
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBBI HOUSTON
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Credential |
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Telephone | 618-392-2940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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