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General NPI Number Information
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NPI Number | 1669978797
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Entity Type | Individual
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Provider Name | HALLIE BRADLEY MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 76 REGENCY PKWY
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City | MANSFIELD
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State | TX
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Zip | 76063-7816
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Country | US
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Telephone | 817-419-0303
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Fax | 833-626-1951
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Provider Business Mailing Address
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Address Line | 3533 MATLOCK RD
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City | ARLINGTON
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State | TX
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Zip | 76015-3604
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Country | US
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Telephone | 817-419-0303
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Fax | 833-626-1951
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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 | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | V0695
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License Number State | TX
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