MEDICARE: BRADLEY TRINIDAD

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	2086S0129X	Vascular Surgery Physician	R75495	AZ
2	2086S0129X	Vascular Surgery Physician	S9814	TX

General Provider Information

NPI Number	:	1578918520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY TRINIDAD

Provider Business Mailing Address
First Line	:	405 LONDONDERRY DR STE 310
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-7922
Country	:	US
Telephone Number	:	254-741-6333
Fax Number	:	806-513-6790

Provider Business Practice Location Address
First Line	:	1301 S COULTER ST STE 200
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-1765
Country	:	US
Telephone Number	:	806-340-0550
Fax Number	:	806-513-6790

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

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	06/30/2025

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Directions to “ BRADLEY TRINIDAD ” Practice Location

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