MEDICARE: BRADLEY NESBIT M.D.

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	2085R0202X	Diagnostic Radiology Physician	29141	MS
2	207R00000X	Internal Medicine Physician	T-2996	MS
3	208D00000X	General Practice Physician	29141	MS
4	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1396126355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY NESBIT M.D.

Provider Business Mailing Address
First Line	:	140 PINE RIDGE CIR
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-7514
Country	:	US
Telephone Number	:	601-209-9109
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 PINE RIDGE CIR
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-7514
Country	:	US
Telephone Number	:	601-209-9109
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	03/11/2022

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