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NPI Code Detail

MEDICARE: DR. TIMOTHY MICHAEL BRADLEY M.D.

MEDICARE: DR. TIMOTHY MICHAEL BRADLEY 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
1207XP3100XPediatric Orthopaedic Surgery PhysicianME87576FL

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 : 1851394746
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY MICHAEL BRADLEY M.D.
Provider Business Mailing Address
First Line : 602 VONDERBURG DR
Second Line : SUITE 103
City : BRANDON
State : FL
Zip : 33511-5900
Country : US
Telephone Number : 813-720-8001
Fax Number :
Provider Business Practice Location Address
First Line : 602 VONDERBURG DR
Second Line : SUITE 103
City : BRANDON
State : FL
Zip : 33511-5900
Country : US
Telephone Number : 813-720-8001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 11/28/2014

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