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General NPI Number Information
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NPI Number | 1609925312
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Entity Type | Organization
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Legal Business Name | BRADLEY W NORDYKE MD
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 3914 PAREDES LINE RD
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City | BROWNSVILLE
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State | TX
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Zip | 78526-1184
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Country | US
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Telephone | 956-982-1696
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Fax | 956-982-2256
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Provider Business Mailing Address
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Address Line | 3914 PAREDES LINE RD
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City | BROWNSVILLE
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State | TX
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Zip | 78526-1184
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Country | US
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Telephone | 956-982-1696
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Fax | 956-982-2256
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADLEY W NORDYKE
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Credential | M.D.
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Telephone | 956-982-1696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | J7115
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License Number State | TX
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