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General NPI Number Information
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NPI Number | 1609863760
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Entity Type | Individual
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Provider Name | BRADLY BUNDRANT M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 2001 HUTCHINS AVE STE C
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City | BALLINGER
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State | TX
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Zip | 76821-4453
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Country | US
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Telephone | 325-365-5737
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 617
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City | BALLINGER
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State | TX
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Zip | 76821-0617
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Country | US
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Telephone | 325-365-5737
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Fax | 325-365-2405
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | H7275
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QS1201X
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Taxonomy Name | Sleep Medicine (Family Medicine) Physician
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License Number | H7275
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H7275
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License Number State | TX
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