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General NPI Number Information
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NPI Number | 1649780453
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Entity Type | Organization
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Legal Business Name | PAUL BRADLEY MD PLLC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 703 E MARSHALL AVE STE 4009
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City | LONGVIEW
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State | TX
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Zip | 75601-5500
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Country | US
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Telephone | 903-315-4455
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3002
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City | LONGVIEW
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State | TX
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Zip | 75606-3002
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Country | US
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Telephone | 903-331-0506
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Fax | 903-331-0462
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL BRADLEY
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Credential | MD
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Telephone | 903-315-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | P6344
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License Number State | TX
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