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NPI Code Detail

MEDICARE: MR. BRADLEY SCOTT BURDETTE I PA

MEDICARE: MR. BRADLEY SCOTT BURDETTE I PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant2264FL

General Provider Information

NPI Number : 1093858771
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRADLEY SCOTT BURDETTE I PA
Provider Business Mailing Address
First Line : 606 RIVERSIDE RD
Second Line :
City : NORTH PALM BEACH
State : FL
Zip : 33408-3726
Country : US
Telephone Number : 561-848-4741
Fax Number :
Provider Business Practice Location Address
First Line : 7240 7TH PL N
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33411-3801
Country : US
Telephone Number : 561-969-6663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2007
Last Update Date : 08/31/2016

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Directions to “ MR. BRADLEY SCOTT BURDETTE I PA” Practice Location

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