MEDICARE: WILLIAM B BRADBURY DPM

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
1	213E00000X	Podiatrist	0549	TX

General Provider Information

NPI Number	:	1184798704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM B BRADBURY DPM

Provider Business Mailing Address
First Line	:	4009 BELLAIRE BLVD
Second Line	:	STE GG
City	:	HOUSTON
State	:	TX
Zip	:	77025-1170
Country	:	US
Telephone Number	:	713-790-0661
Fax Number	:	713-668-4253

Provider Business Practice Location Address
First Line	:	4009 BELLAIRE BLVD
Second Line	:	STE GG
City	:	HOUSTON
State	:	TX
Zip	:	77025-1170
Country	:	US
Telephone Number	:	713-790-0661
Fax Number	:	713-668-4253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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