MEDICARE: BRAD E. MCCOLLOM DO

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	207T00000X	Neurological Surgery Physician	OS9270	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48160	OTHER	FL	BCBS FL

General Provider Information

NPI Number	:	1548264385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD E. MCCOLLOM DO

Provider Business Mailing Address
First Line	:	8005 BAY ST STE 5
Second Line	:
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3244
Country	:	US
Telephone Number	:	772-581-8075
Fax Number	:	772-581-8031

Provider Business Practice Location Address
First Line	:	8005 BAY ST STE 5
Second Line	:
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3244
Country	:	US
Telephone Number	:	772-581-8075
Fax Number	:	772-581-8031

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/08/2017

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Directions to “ BRAD E. MCCOLLOM DO” Practice Location

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