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General NPI Number Information
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NPI Number | 1356370852
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Entity Type | Individual
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Provider Name | BRIAN KEITH KRADEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 726 GULF AIRE DR
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City | PORT SAINT JOE
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State | FL
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Zip | 32456-6123
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Country | US
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Telephone | 850-866-6444
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Fax |
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Provider Business Mailing Address
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Address Line | 726 GULF AIRE DR
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City | PORT SAINT JOE
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State | FL
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Zip | 32456-6123
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Country | US
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Telephone | 850-866-6444
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 54323
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 12932
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME63649
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License Number State | FL
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