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NPI Code Detail

MEDICARE: BRADLEY M GARDEN MD

MEDICARE: BRADLEY M GARDEN MD
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
1390200000XStudent in an Organized Health Care Education/Training Program4301107046MI
2390200000XStudent in an Organized Health Care Education/Training ProgramNY
3208800000XUrology PhysicianME144394FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174901581
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY M GARDEN MD
Provider Business Mailing Address
First Line : 5850 CORAL RIDGE DR
Second Line : STE 106
City : CORAL SPRINGS
State : FL
Zip : 33076-3379
Country : US
Telephone Number : 954-714-8200
Fax Number : 954-840-2626
Provider Business Practice Location Address
First Line : 5850 CORAL RIDGE DR STE 106
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33076-3379
Country : US
Telephone Number : 954-714-8200
Fax Number : 954-840-2626
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2015
Last Update Date : 08/31/2021

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Directions to “ BRADLEY M GARDEN MD” Practice Location

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